Tag Archives: Harvard

HARVARD STUDY: VITAMIN D LOWERS THE RISK OF YOUNG-ONSET COLORECTAL CANCER

COMMENTARY:

Vitamin D has many beneficial effects, but my comments will be restricted to the effect of vitamin D on cancer.

Interest in this association was started by the observation that certain cancers are less common near the equator, where there is more sunlight exposure, and therefore more natural vitamin D generation in your skin.
The most information on cancer in humans Is available on colorectal, breast, prostate, and pancreatic cancer. Colorectal cancer, highlighted DWW our posting, is the only cancer that apparently is affected by vitamin D.

Several studies have suggested that vitamin D can decrease cancer cell growth, stimulate cell death, and reduce cancer blood vessel formation. Increasing cell death, or apoptosis, is what interests me the most, since this is one of the factors which increases inflammation in aging.

The infographics stated that only 300 international units of vitamin D is necessary to produce a 50 Percent reduction in cancer, and that a healthy diet generally supplies this.

I personally take 5000 international units vitamin D. This produces a blood level of about 60 ng/mL, and what the NFL recommends to keep their players healthy, and well within the maximum recommended level of 120 ng/milliliter.

Excessive vitamin D can produce an elevated calcium blood level, and mine is within normal limits. I take the higher dose because of vitamin D’s other effects, such is benefiting the immune system in a time of Conid-19.

I suggest that you get a vitamin D blood level, and also a calcium blood level if you elect to take more of this useful vitamin.

–Dr. C

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ATHEROSCLEROSIS: STRESS, LACK OF SLEEP & EXERCISE AND POOR DIET RAISE RISKS

Swirski acknowledged that “there is no question” that genetics play a role in cardiovascular health, but in the last several years, four risk factors — stress, sleep interruption or fragmentation, diet, and sedentary lifestyle — have been clearly identified as contributing to atherosclerosis, commonly referred to as hardening of the arteries, which can lead to a variety of complications, including death.

VIEWS: IS U.S. HEALTHCARE SYSTEM BROKEN? (HARVARD)

Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.

Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.

The cost is enormous

  • High cost, not highest quality. Despite spending far more on healthcare than other high-income nations, the US scores poorly on many key health measures, including life expectancy, preventable hospital admissions, suicide, and maternal mortality. And for all that expense, satisfaction with the current healthcare system is relatively low in the US.
  • Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.

Access is uneven

  • Health insurance tied to employment. During World War II, healthcare was offered as a way to attract workers since employers had few other options. Few people had private insurance then, but now a layoff can jeopardize your access to healthcare.
  • Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
  • Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.

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Dr. C Commentary:

Please refer to the DWWR Posting on “concierge doctors” for my rant on the current healthcare system, which I will not repeat.

The truth is more nuanced. All countries are having trouble of one sort or another with their healthcare systems. This is due to the inherent expense of today’s top flight medicine. The very best care requires costly high technology and drugs that are intrinsically hard to produce. And you have to know where to look. I am very thankful for my medical degree, and that I have kept up with current advances.

You would probably need a Government entirely of physicians to develop the willpower to do something for health, which always starts with PREVENTATIVE MEDICINE, A hard sell, given that you must spend money and effort to block something which will probably, but may not always, occur.

There is low hanging fruit. Why are sugary drinks not heavily taxed, since they produce obesity which causes a lot of costly medical disorders, such as diabetes, inflammatory diseases, and cancer, but not everybody all the time?

Why is efficiency of telehealth not more widely embraced, but stymied by moneymaking lobbiests and lawyer powered difficulties, in addition to Patient’s and doctor’s old habits?

And then there are the jealously guarded  American freedoms to do stupid things, such as avoid vaccines and masks, even in a prodigiously expensive and dangerous Covid  epidemic.

Given human nature, a complete solution would seem to be impossible, and we should content ourselves with minor victories wherever they can be attained.

Embrace sleep, diet, and exercise, and KEEP HEALTHY.

–Dr. C

Osteoporosis: Study Finds Up To 40% Greater Risk Of Hearing Loss In Women

 As part of the Conservation of Hearing Study (CHEARS), researchers from Brigham and Women’s Hospital analyzed data from nearly 144,000 women who were followed for up to 34 years. They found that risk of subsequent moderate or worse hearing loss was up to 40 percent higher in study participants with osteoporosis or LBD. The study, published in the Journal of the American Geriatric Society, also found that bisphosphonates did not alter risk of hearing loss.

The researchers found that a history of vertebral fracture was associated with up to a 40 percent higher risk of hearing loss, but the same did not hold true for hip fractures, the two most common osteoporosis-related fractures. “The differing findings between these skeletal sites may reflect differences in the composition and metabolism of the bones in the spine and in the hip,” Curhan said. “These findings could provide new insight into the changes in the bone that surrounds the middle and inner ear that may contribute to hearing loss.”

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HEALTH: ‘RISKS & BENEFITS OF AI REVOLUTION IN MEDICINE’

It has taken time — some say far too long — but medicine stands on the brink of an AI revolution. In a recent article in the New England Journal of Medicine, Isaac Kohane, head of Harvard Medical School’s Department of Biomedical Informatics, and his co-authors say that AI will indeed make it possible to bring all medical knowledge to bear in service of any case.

Properly designed AI also has the potential to make our health care system more efficient and less expensive, ease the paperwork burden that has more and more doctors considering new careers, fill the gaping holes in access to quality care in the world’s poorest places, and, among many other things, serve as an unblinking watchdog on the lookout for the medical errors that kill an estimated 200,000 people and cost $1.9 billion annually.

“I’m convinced that the implementation of AI in medicine will be one of the things that change the way care is delivered going forward,” said David Bates, chief of internal medicine at Harvard-affiliated Brigham and Women’s Hospital, professor of medicine at Harvard Medical School and of health policy and management at the Harvard T.H. Chan School of Public Health. “It’s clear that clinicians don’t make as good decisions as they could. If they had support to make better decisions, they could do a better job.”

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STUDY: “ANTI-INFLAMATORY” DIET OF VEGETABLES, FRUITS, COFFEE & TEA LOWERS HEART DISEASE AND STROKE RISKS

Dietary patterns with a higher proinflammatory potential were associated with higher CVD risk. Reducing the inflammatory potential of the diet may potentially provide an effective strategy for CVD prevention.

Background

Inflammation plays an important role in cardiovascular disease (CVD) development. Diet modulates inflammation; however, it remains unknown whether dietary patterns with higher inflammatory potential are associated with long-term CVD risk.

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TELEHEALTH: ‘ADVANTAGES & DISADVANTAGES’ (HARVARD)

Telehealth is defined as the delivery of health care services at a distance through the use of technology. It can include everything from conducting medical visits over the computer, to monitoring patients’ vital signs remotely. Its definition is broader than that of telemedicine, which only includes the remote delivery of health care.

Telehealth can be delivered in one of three ways:

  • Synchronous—when the doctor communicates with the patient in real time via computer or telephone
  • Asynchronous—when data, images, or messages are recorded to share with the doctor later
  • Remote patient monitoring—when measurements such as weight or blood pressure are sent to the health care provider

What you can do with telehealth

All of the following activities and services are possible with the help of telehealth:

  • Recording measurements like your weight, food intake, blood pressure, heart rate, and blood sugar levels either manually, or through a wearable device, and sending them to your doctor.
  • Having a virtual visit with your doctor or a nurse over your computer or smartphone.
  • Using an online portal to check your test results, request prescription refills, send your doctor a message, or schedule an appointment.
  • Sharing information such as your test results, diagnoses, medications, and drug allergies with all of the providers you see.
  • Coordinating care between your primary care provider and any specialists you visit—including the sharing of exam notes and test results between medical offices in different locations.
  • Getting email or text reminders when you’re due for mammograms, colonoscopies, and other screenings, or routine vaccinations.
  • Monitoring older adults at home to make sure they are eating, sleeping, and taking their medications on schedule.

Downsides to telehealth

Telehealth offers a convenient and cost-effective way to see your doctor without having to leave your home, but it does have a few downsides.

  • It isn’t possible to do every type of visit remotely. You still have to go into the office for things like imaging tests and blood work, as well as for diagnoses that require a more hands-on approach.
  • The security of personal health data transmitted electronically is a concern.
  • While insurance companies are increasingly covering the cost of telehealth visits during the COVID-19 pandemic, some services may not be fully covered, leading to out-of-pocket costs.

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PRESCRIPTION DRUGS: ‘WHY THEY REMAIN HIGH-PRICED’

There may be few issues that unite Americans ahead of the 2020 election as do their concerns about the cost of prescription drugs.

A clear majority — 75% — of respondents to a July survey said the cost of prescription medicines would be among the factors likely to influence their votes this year, according to a report from Gallup and the nonprofit West Health. Gallup reported on results from 1,007 interviews conducted with adults between July 1 and July 24.

1. What are the 2020 presidential candidates saying they will do to lower drug prices?

Both President Donald Trump, a Republican, and former Vice President Joe Biden, a Democrat, have highlighted insulin costs in their discussions of the need to lower drug prices.

In a January interview with the New York Times editorial board, Biden noted the widespread discontent among Americans about sticker shock often experienced at pharmacies. He spoke of a need for the federal government to act to make medicines more affordable.

“This is a place where I find, whether you’re Republican or Democrat, you think you’re getting screwed on drug prices. And you are, in terms of everything from insulin to inhalers and a whole range of other things,” Biden said. “So, again, can I guarantee that it gets done? No, but I can tell you what, if anybody can get it done, I can, and I think there’s a consensus for it.”

2. Why doesn’t Medicare, the biggest U.S. purchaser of drugs, directly negotiate on drug prices?

Congress has taken different approaches in designing the terms under which the two largest federal health programs, Medicaid and Medicare, buy drugs.

Medicaid is a program run by states with federal contributions and oversight. It covers people with low incomes and disabilities. Almost 67 million people were enrolled in Medicaid as of May 2020, including about 29 million children. In 1990 Congress decided that drugmakers who want to have their products covered by Medicaid must give rebates to the government. The initial rebate is equal to 23.1% of the average manufacturer price (AMP) for most drugs, or the AMP minus the best price provided to most other private-sector payers, whichever is greater. An additional rebate kicks in when prices rise faster than general inflation.

3. What’s the deal with rebates and discounts?

There’s widespread frustration among lawmakers and policy analysts about the lack of clarity about the role of middlemen in the supply chain for medicines. Known as pharmacy benefit managers (PBMs), these businesses describe the aim of their business as making drugs more affordable for consumers. Insurers like Cigna and UnitedHealth operate some of the nation’s largest PBMs, as does pharmacy giant CVS Health, which also owns insurer Aetna.

“They will tell you their mission is to lower drug costs,” said Rep. Earl L. “Buddy” Carter, a Georgia Republican, a pharmacist and a critic of PBMs, in a speech on the House floor last year. “My question to you would be: How is that working out?”

4. What is the “distinctly American” phenomenon of specialty drugs?

Kesselheim also has written on what he terms “Specialty Drugs — A Distinctly American Phenomenon.” That’s the title of a 2020 paper in the New England Journal of Medicine Kesselheim authored with Huseyin Naci, an associate professor of health policy at the London School of Economics.

In this Perspective article, Kesselheim and Naci look at how the “specialty” designation morphed from its origin in the 1970s. It then referred to a need for extra steps for preparation and delivery of new injectable and infusion products.

5. How much does it cost to bring a new drug to market anyway? 

The median cost for a medicine developed in recent years was $985 million, according to a study published in JAMA in March 2020, “Estimated Research and Development Investment Needed to Bring a New Medicine to Market, 2009-2018.”

“Rising drug prices have attracted public debate in the United States and abroad on fairness of drug pricing and revenues,” write the study’s authors: Olivier J. Wouters of the London School of Economics; Martin McKee of the London School of Hygiene and Tropical Medicine; and Jeroen Luyten of Leuven Institute for Healthcare Policy, KU Leuven, Belgium. “Central to this debate is the scale of research and development investment by companies that is required to bring new medicines to market.”

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TOP NEW BOOKS ON AGING: “EXERCISED” BY DANIEL E. LIEBERMAN – “EXTENDING LONGEVITY” (HARVARD)

HARVARD MAGAZINE (SEPT – OCT 2020): From the book EXERCISED: Why Something We Never Evolved to Do Is Healthy and Rewarding by Daniel E. Lieberman, to be published on September 8, 2020 by Pantheon Books:

‘….many of the mechanisms that slow aging and extend life are turned on by physical activity, especially as we get older. Human health and longevity are thus extended both by and for physical activity.’

What Happens When We Exercise?
The graph breaks total energy expenditure (TEE) into two parts: active energy expenditure, and resting metabolism. Resting metabolism remains elevated for hours even after exercise ceases, burning additional calories in a phase known as excess post-exercise oxygen consumption (EPOC).

Exercise is like scrubbing the kitchen floor so well after a spill that the whole floor ends up being cleaner. The modest stresses caused by exercise trigger a reparative response yielding a general benefit.

In order to elucidate the links between exercise and aging, I propose a corollary to the Grandmother Hypothesis, which I call the Active Grandparent Hypothesis. According to this idea, human longevity was not only selected for but was also made possible by having to work hard during old age to help as many children, grandchildren, and other younger relatives as possible survive and thrive. That is, while there may have been selection for genes (as yet unidentified) that help humans live past the age of 50, there was also selection for genes that repair and maintain our bodies when we are physically active.

Daniel E. Lieberman is a paleoanthropologist at Harvard University, where he is the Edwin M Lerner II Professor of Biological Sciences, and Professor in the Department of Human Evolutionary Biology. He is best known for his research on the evolution of the human head and the evolution of the human body.

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COMMENTARY

Daniel Lieberman, a Cultural Anthropologist from Harvard, makes the case that paleolithic hunter-gatherers Grandparents were helpful, in fact necessary to their families, and evolved to be active into old age. They did not evolve to sit in front of the TV, and modern men pay a penalty if they do.

INACTIVITY at ANY AGE is bad. If you put 20 year olds to bed, both weight and blood pressure go up. The book addresses a conundrum. Free radicals are bad. Exercise runs O2 through the mitochondria, which produces free radicals.

But EXERCISE REDUCES FREE RADICALS. A metaphor is introduced: you spill some tomato juice on the floor. But you clean it up, and the floor becomes cleaner than it was before. You exercise, the muscles suffer some microtears and injury. The REPAIR RESTORES the muscles to better than before, maybe with some extra mitochondria.

The Bodies MECHANISMS are MEANT TO BE USED. DIET is meant to supply the body energy and units for repair, EXERCISE is meant to use that energy, and keep the mechanism lubricated, and SLEEP is meant to allow for time to accomplish repair.

Sleep, Diet and Exercise can all be reconciled by recourse to Paleolithic man, whose activities imprinted our modern bodies.

–Dr. C.