Possible step ahead in kidney transplant science

Delayed graft function (DGF) is a set of unfavorable conditions that starts with inflammation after a cadaveric kidney transplant and can cause damage to a newly implanted kidney--and even force the patient to return to dialysis. Now a Tokyo company (Y's Therapeutics) is conducting the first clinical trial of YSPSL, a substance that has been shown in animal models to block a type of molecule (P-selectin) from binding to its receptors on the white blood cells--which is a first step in inflammation--and thus hopefully prevent delayed graft function.

Preventing adhesion of molecules. Such a seemingly small thing that makes it clear why science must proceed in the tiniest ways toward the even the greatest discoveries. Read and listen to more about delayed graft function .here

Brushing your teeth is good for your heart

Evidence already existed that periodontal health was related to heart health, and a recent study at Columbia University gives the idea greater credibility. Researchers found a direct relationship between the presence of bacteria for gum disease and thickness of carotid artery (indicating artherosclerosis).

While they cautioned that other factors in overall health (such as diet and exercise) may also be at work, the findings show there may be a predictive relationship for possible stroke or heart disease in people who develop gum disease. This is the kind of discovery that gets made when cross-functional teams combine strong epidemiologic design and methods with microbiology and imaging.

Health care trends

Stumbled on some notes I took several months ago when some of the most prominent medical leaders in Cleveland all came together on a panel and actually answered questions from the audience. Fred C. Rothstein, MD President and Chief Executive Officer,
University Hospitals of Cleveland, talked about trends:

• Diseases will spread through many countries with the decline in the effectiveness of antibiotics
• One-fifth of U.S. citizens will be growing older.
• The population will double within the next generation.
• Fifteen chronic conditions will constitute 80% of health care costs in the U.S.
• By 2020, there will only be two people working for every person who is retired. Now, more people are taking care of aging parents than are taking care of children.
• Some companies (he mentioned Lucent) are phasing out retirement benefits.
• Diagnostics will improve (in vitro, imaging, etc.). Treatments will be tailored to the individual's disposition and symptoms. Focus will be on prevention. molecular intervention, and lifestyle modification.

Costs for end-of-life care are 10-12% of the country's total health care budget--27% of Medicare. One-third of Medicare spending is in the last year of lilfe--40% of it in the last 30 days of life. Hospice care can save 25 to 40% in health care costs.

I once stumbled on a television interview in which the speaker said more and more people in America will have to be working until they are 80 years old. Of course, that would be those who manage to live that long. It comes down to this: the time-honored American dream of retirement is heading the way of the fully-paid-medical-benefits-for-everybody phenomenon--into ancient history.

I asked what would stop the outrageously upward spiral of health care in America--his answer was: when people start having to pay for it themselves. Well, we're getting there quickly. Fortunately, getting funding for research doesn't depend on how much is spent on health care delivery. With the dramatic advances being made in stem cell therapies, genetics, and other areas, we have good reason to feel hope that a lot of healing will soon become not only cheaper but also much more natural and less intrusive.

So, okay. Even if we can't retire, science is every day finding ways to help us live a better quality of life until the day we do have to go.

Science measures stress

Up until recently, all we could say about stress was that it wasn't good for you. Maybe we could measure your heart rate and your blood pressure and so on, but there wasn't a reliable way to measure its effects while it was going on and at other times.

Here's a story about a new way of measuring blood flow to the part of the brain that controls negative emotions and depression--and stress. Scientists have found a way to see what's going on during the stress period itself and afterwards as well.

But this method is one that only scientists can use. Complex equipment and lab conditions are required. There's another way that even you, sitting at your own desk, can measure your stress--and what's more control it. It's called the Freeze Framer and with a simple finger sensor it records the "coherence" of your heart rhythms (electrical activity and so on that is different from the heart rate). The FF is described as an interactive learning system (somewhat like the old biofeedback mechanisms but less complicated to use).

If you haven't read yet about how some of America's biggest companies are sending their executives to learn to use this system to reduce their stress and boost their creativity, do so soon. It's quite enlightening.

Stem cell progress

The fact that embryonic stem cells can develop into nearly any variety of human tissue makes them incredibly powerful tools in efforts to heal a host of human diseases and conditions. But the controversy surrounding their use is full of passion and anger from those who believe that even a bundle of 8 cells is a human being and should receive the full protection of the law regarding its right to life.

Two new discoveries offer promise of leading to ways to overcome human rights objections--though neither is yet free of its own complications. Since this issue hinges directly on the seemingly-eons-old debate about the moment that life begins, a swift resolution isn't likely. But scientists are stepping up the search because they realize that no matter what their personal beliefs are, they can't ignore the sizeable portion of society that thinks embryonic stem cells are off-limits as methods for curing human suffering.

The answers will come eventually. The universe would not in its infinite wisdom give humans the ability to discover the power of stem cells without also providing the solution to the objections. So once again as always, one step forward, two steps back.

New markers predict recurring ishemic stroke

Once you've had a stroke, your chances are higher of having another--not a delightful thing to know for previous stroke sufferers. Now science has found another way to predict who is more likely to have another stroke--in time for doctors to take preventive action. Read about it in the Archives of Neurology.

It's easy to dismiss things if your life has never been touched by them. If you know anyone who's had a stroke, you'll know how welcome this new method is for helping those persons feel a greater sense of control over their destiny.

We're off to work on an out of town project this week and will be out of touch. Look for us again next week.

Health care system ill-equipped to handle cancer survivors

Okay. We're doing what was thought impossible a few decades ago--curing cancer (at least some kinds). Now we're finding that we aren't well prepared to help survivors live well afterwards. The myriad of issues that exist for those who go back to the world after having survived cancer was addressed at a recent Institute of Medicine conference.

Legal questions about insurance issues (insurance companies are notoriously uninterested in taking on anyone with a known serious disease or condition--past or present) are among the most challenging. How will the costs of followup care be assigned? Insurance companies won't want to bear. Doctors can't afford to give their services away. Patients and their families--who increasingly, as the cost of health insurance steadily climbs, may have gone into debt already from the treatments themselves--will hardly be in a position to support high medical bills over the long term.

Conference attendees discussed training physicians to provide survivors with a carefully laid out "care plan" (including ways to reduce recurrence and ways to get help with the many other problems they will face). I wonder if the oft-mentioned, much-maligned subject of a national health care system came up at all.

Vitamin D Status More Important Than High Calcium

Science has long known the relationship between calcium and vitamin D. Now, a new study suggests you don't need to take a bunch of calcium if your vitamin D levels are sufficient. This could have interesting implications for menopausal women if further studies confirm the findings.

The study was conducted in Iceland--a place not known for heavy-duty concentrations of sun (to provide vitamin D)--and its investigators suggest that probably most people who live in northern climates ought to be taking vitamin D supplements rather than calcium.

Here are a few selected items from Harvard U's Health Services on the calcium/vitamin D mix:

Dairy products are among the richest sources of calcium (nonfat and low-fat work as well as those made from whole milk. Milk’s added Vitamin D (100 IU/cup) and natural lactose (the natural sugar in milk) also help your body absorb the calcium.

Other sources of calcium include: green leafy vegetables, (like bok choy, collards, and kale)
sardines
broccoli
most tofu
calcium-fortified orange juice
fortified cereals

Other Factors: Positive Calcium Balance
Exercise that causes muscles to tug at bones, or is weight bearing, also helps keep bones strong. Good examples are walking, low-impact aerobics and dancing.

Vitamin D is key to calcium absorption. Vitamin D is manufactured in the skin following exposure to sunlight*. This varies, however, with: time of day
season
latitude
skin pigmentation
use of sunscreen
age.

It is estimated that 30-40% of adults over 50 are vitamin D-deficient. Vitamin D deficiency accelerates bone loss and increases the risk of fractures.

*Sunlight in Cambridge, MA provides inadequate vitamin D between October and April.

Hey, I thought I'd read somewhere that baked potatoes had significant calcium, too, but it turns out it's really just the lowfat yogurt I put on them.

How well do you sleep?

If you're over 50, says this review of a study by the International Longevity Center, you probably don't trust sleeping pills. But half of you might be happy to use other techniques to get a decent night's sleep (e.g., music, herbal remedies, OTC antihistamines, OTC sleep aids, other medications that make you drowsy, alcohol)

In case you're like me and you like to know where you fit in the spectrum of "normal," here are the stats on who's getting a good sleep in the over-50 crowd:

• 32% of respondents reported getting a good nightís sleep all seven days of the week.
• 29% said they are able to get a good nightís sleep five or six days a week, while 26% reported getting a good nightís sleep from two to four nights.
• 8% said they never get a good night's sleep.
• 20% reported getting less than six hours sleep each night.
• 26% said they get between six but less thanand seven hours sleep, while 31% reported getting seven but less thanto eight hours sleep each night.

I'd like to see a comparison study of how the under-50s sleep and what they use to help.

But it's also interesting to see that this Ph.D. argues with a lot of sleep studies about that 8-hour requirement (who sleeps that much anyway?--except maybe your teenagers). His conclusion is that more isn't better, and that moderation (about 7 hours) will help you live longer.

Ho-hum. Moderation...again. Nothing new under the sun.