August 31, 2015

God Save the "New York Times"

Every Sunday morning for years, I've stepped out the front door to pick up my New York Times and Washington Post from the sidewalk, yard, or curb... depending on the delivery driver's aim.

During Ben Bradlee's 26 years as editor, the Post increasingly challenged the Times as the best in American journalism. No more.

Digital Journalism
The Times is considered a top innovator with web journalism, particularly multimedia and interactive data. It recently announced that it had reached a new milestone: one million digital-only subscribers.

As a subscriber to the Sunday-only Times, I can access its many digital offerings. Here's one example.

The Times Weekly Wrap
Every Saturday, I receive an email with "The Times Weekly Wrap," which "takes readers behind the scenes of the New York Times newsroom to show how its journalists work and how decisions are made."

Sounds boring, and sometimes it is. But then I find something like last week's posting, "Where Are U Now That I Need You?" -- the name of the million-selling single by Skrillex and Diplo with Justin Bieber. The song, which Times music critic Jon Pareles calls "four minutes of high-tech bliss," was the subject of a series of articles that ran last week about how pop music is made today.

I have little interest in pop music, but I really liked the song:

August 27, 2015

Two TED Talks Related to Upcoming Discussion of Brain Healing and Parkinson's

It's 9pm Thursday, and I'm just getting around to writing today's post. So, looking for something quick and easy, I came up with these two TED talks. I had saved them because they relate to a post I intend to run next week on neural plasticity (the brain's ability to heal itself) and Parkinson's.

First comes the highly popular talk by the positive psychology expert Shawn Achor. Most people believe that once they land that long-awaited promotion, make more money, get their kids into the right schools, lose a few pounds or find a meaningful relationship, then they'll be happy. But based on recent discoveries in the fields of positive psychology and neuroscience, Achor says this formula has it backwards. As it turns out, happiness actually fuels success, not the other way around.

Achor's TED talk has been viewed by millions. It's a bit too slick and cute for my taste. Much more to my liking is this talk by Dr. Libby McGugan, an emergency physician from Glascow, Scotland. When I looked at the video, YouTube showed 1,682 views. You go, girl!

August 26, 2015

Another Call for "Less Medicine, More Health"

That's the title of an excellent book by Dr. H. Gilbert Welch.

An internist at the White River Junction Veterans Administration Medical Center in Vermont, and a researcher at the Dartmouth Institute, Welch presents an informal, witty, and wise argument that less "care" may result in better health and less harm to the patient.

He systematically debunks seven widely held assumptions about the value of more tests and treatments. His book is "more narrative, with fewer numbers, and perhaps most importantly, no scary tabular and graphical data and no superscript references."

The Seven Assumptions
Welsh devotes a chapter to each assumption, and he ends each chapter with a "prescription" of simple, actionable strategies to avoid too much medical care.

August 25, 2015

Nine Risk Factors for Alzheimer's

An article published online last week in the Journal of Neurology, Neurosurgery & Psychiatry describes nine risk factors for Alzheimer’s disease (AD). The data from this study suggests that these nine factors contribute to two thirds of all AD cases worldwide.

What’s more, these remarkably varied risk factors are all modifiable; there is something we can do about them. That’s important because there is no cure for the disease that affects over 44 million people around the world… and hundreds of millions of family members and caregivers.

Eager to study the complexity of AD development, researchers in China and California undertook a monumental enterprise: reviewing all relevant studies published in English from 1968 to July, 2014 (in PubMed and the Cochrane Database of Systematic Reviews).

From the 16,906 studies they reviewed, the scientists identified 323 that offered data they could include in their own study. From those 323 studies, the team found 93 separate possible AD risk factors that involved more than 5,000 people.

Because they were especially concerned with the causes – the complexity – of dementia development, the researchers pooled the metadata from all the applicable studies and evaluated the evidence based on its strength.

First, the Evidence
The team found “grade 1 level evidence” (evidence obtained from at least one properly designed randomized controlled trial) that the following medical exposures were protective against dementia development: 
  • The female hormone estrogen
  • Statins (cholesterol-lowering drugs)
  • Drugs to lower high blood pressure
  • NSAIDS (non-steroidal anti-inflammatory drugs)
The scientists found the same quality of evidence – protective against AD – for these dietary exposures:
  • Folate (a water-soluble B vitamin naturally present in some foods, added to others, and available as a dietary supplement)
  • Vitamins C and E
  • Coffee

On the other hand, the scientists found a strong association between the following and a heightened risk of developing AD:

August 21, 2015

CurcuWIN: A Caution and an Example of Patient Forum Usefulness

A few days ago, I reported that I planned a switch to the CurcuWIN brand of curcumin -- the active ingredient of the Indian curry spice turmeric -- known for its effective anti-inflammatory properties.

A recent update about curcumin supplements by ConsumerLab prompted my decision.

I'm a member of two online forums for people with Parkinson's: Patientslikeme and HealthUnlocked. Before bedtime last night, I sent posts to both forums about my planned switch to CurcuWIN.

This morning, two responses awaited me, both from a HealthUnlocked member.

August 20, 2015

Exercise for My Aging Brain: Less Is Not More but It Might Be Good Enough

No doubt I'll never find a study that claims less exercise is better than more. However, a new study suggests that a small amount of exercise may improve our ability to think as we age... and that more exercise may not necessarily be better.

We all know that working out is good for us. But precisely how much exercise do we need to gain various health benefits? Is the same dose of exercise that promotes heart health equally good for brain health?

For the new study, scientists at the University of Kansas Alzheimer's Disease Center tried to determine just how much exercise we need to improve our thinking skills.

The team recruited 101 sedentary, healthy adults with no symptoms of dementia or cognitive impairment. Those subjects were all 65+, the age when people typically begin to show worrisome declines in memory and cognition.

August 19, 2015

Sleeping on Your Side May Lower Alzheimer’s Risk

If you sleep like the guy in this picture, you may be lowering your risk of developing dementia.

We’ve heard some interesting things about sleep recently:
  • Poor sleep increases the risk of heart attack and stroke.
  • Poor sleep is linked to an increased risk of dementia.
  • Sleep creates better conditions for the body to remove dangerous waste products from the brain... the same toxic materials – like amyloid beta and tau proteins -- that accumulate and are now considered hallmarks of both Alzheimer’s disease (AD) and Parkinson’s disease (PD).

Now, as reported in The Journal of Neuroscience, there's a new twist on sleep and health: Sleeping on your side might very well reduce your risk of developing Alzheimer’s.

The Glymphatic System
An international team of researchers led by scientists at Stony Brook University in New York investigated the complex brain cleansing system that removes harmful substances that jeopardize the normal functioning of cells and tissue. That purifying “glymphatic system” filters cerebrospinal fluid (CSF) through the brain and exchanges it with interstitial fluid (ISF) to clear away neural waste, like toxic misfolded proteins.

That glymphatic network works in the brain the same way that the lymphatic system functions to flush out harmful waste products from other organs in the body.

Using magnetic imaging, the research team observed that the brain flushing system worked best when the test subjects were sleeping on their sides -- in the lateral position – and not on their backs or on their stomachs.

August 18, 2015

I’m Switching to a Different Curcumin Supplement: CurcuWIN

I've written several posts about curcumin, the active ingredient in turmeric, the curry spice Indians call the "holy powder." Curcumin/turmeric has a rich history in ancient cultures, both for it culinary and medicinal uses.

Today, modern science is confirming the folklore about turmeric/curcumin's benefits. Almost 5,000 peer-reviewed studies now exist to confirm its beneficial effects. Curcumin has powerful antioxidant properties, which means it can fight inflammation. Many diseases are accompanied by inflammation and -- according to some research -- prompted by it

What's especially exciting is curcumin's potential to fight Alzheimer's, Parkinson's, and other neurological disorders known to have inflammation connections. Several studies have indicated that curcumin could slow the progression of Parkinson's.

Almost every day, I see promising new studies about curcumin. Here's one I found yesterday:
Turmeric Blocks Cancer Cells – Which Chemotherapy Can't Do!
When I began reporting on this botanical supplement, I complained that it wasn't getting the attention it deserved. But today, it makes the list of top ten supplements in the United States.

August 14, 2015

Dr. Atul's Gawande's Excellent Commentary on "Less is More" in Healthcare

 I've posted about Gawande before. Several friends and blog readers have thanked me for recommending Gawande's book Being Mortal in which this surgeon/author, after dealing with the final illness of his father, meditates on how we can better deal with age-related frailty, serious illness, and approaching death. He is a wonderful writer and thinker.

The Less-is-More Movement
Last week I talked about this trend. It aims to reduce the use of practices that offer little or no value and instead put patients at unnecessary risk. Researchers estimate that these practices account for a large part of the hundreds of billions of healthcare dollars wasted every year.

Six years ago, Dr. Gawande wrote about the problems of unnecessary health care in McAllen, Texas, where Medicare costs were among the highest in the country. Since then, Medicare costs have flattened across the country, but he found that they've dropped dramatically in McAllen. Many health outcomes have improved there, too.

August 13, 2015

"If Vadim Could Thumb His Nose at the State of Modern Medicine, Doubtless He Would"

More than anyone else I know, Mark Medish has been intensely involved with our healthcare system. His son Vadim -- treated at three major hospitals -- has lingered in a difficult, semi-responsive state for the past two and a half years.

Mark keeps his family and friends updated on Vadim's situation with moving, beautifully written posts on Caring Bridges. He often expresses his gratitude to the doctors and other healthcare professionals who care for his son.

But last week, Mark described his frustration with the "the inexplicable complexities of our healthcare system," the lack of communication among specialists, and the rarity of outside-the-box thinking. With Mark's permission, I've shared that portion of his post, below.

But first, a brief summary of Vadim's story: Stricken in his second semester as a freshman at Harvard, Vadim was eventually diagnosed with a rare autoimmune disorder called "paraneoplastic syndrome" that led to devastating encephalitis. His hospitalization started on March 26, 2013, at Boston Children's Hospital. A month later, Vadim was transferred to Johns Hopkins in Baltimore. After almost five months there, he moved to National Children's Hospital in Washington D.C.

He's been at home since mid-July. His grandfather told me today that Vadim had enjoyed three hours on the back deck of their house.

Here is Mark's recent commentary on our healthcare system, in his own words:


This has been another exercise in the inexplicable complexity of our health care system. Different departments in the same hospital do not communicate with each other in real time to brainstorm and to arrive at a unified theory of the case. Really? A surgeon responding to a basic question with the haughty quip "if you don't trust my work, you should speak to somebody else." Mamma mia! A disembodied voice at a doctor's office at another hospital contacted for a second opinion absurdly asserts they will speak only with other doctors "as a matter of policy." Oy vey!

August 12, 2015

AGING WELL: Margaret -- 97 and Happy at Home with Wheeler the Cat

Last week, I began a series about people I know who seem to be AGING WELL. Here’s the second installment, which appears just as my friend Daniel sent it to me. This is a perfect example of what I mean by "aging well." It's not, as the media suggest, swimming the English Channel at an advanced age. It's aging happily, successfully, day by day.


I’ve been a friend of John’s for 23 years. A week ago, he told me he was beginning an “AGING WELL” series on his blog, and asked if I’d briefly profile my 97-year-old mother, Margaret. The two of them met some years back, and John hears occasional updates from me about her life and well-being.

This past weekend, I told my mother about John’s request. Would she mind if I wrote something about her… something that would be posted on John’s very public blog? A private person, my mom surprised me with her answer: “Anything for John.”

Margaret lives happily in her own home with Wheeler, her beloved brown tabby cat. She cooks and cleans, manages her own affairs, still plays the piano a little, and takes care of her small lawn and garden.

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Last month, while looking for a yardstick in a closet at my mother’s house, I found her yearbook from Pottsville (PA) High School, class of 1936. Here’s her graduation photo in that book, taken when she was 17 years old:

The comments written by her many friends 79 years ago included several repeated phrases, like “best friend,” “wonderful musician and singer,” “so much fun,” “happy,” and “don’t ever change.”

I realized that my old mum is the same person her classmates admired so long ago. Those teenagers sought the pleasure of her company just as people do now.

If asked, my mother would modestly describe herself as a simple, ordinary person. But – in my opinion, anyway -- her special gifts are anything but ordinary.

Those gifts – and the blessing of good health for so many years – have brought my mother safely and happily to this amazing time in her life. I’ll list a few of them here – just a few -- to help explain why she might be “aging well.”

August 11, 2015

Last Saturday Turned Out To Be an "I Love My Life" Day

Once upon a time, I could handle Washington's hot, humid summers. Even on the worst days, I'd be with the "mad dogs and Englishmen," biking "out in the midday sun."

But for several years now, those extremes of summer enervate me. Quite a few times, I've nearly fainted outside in the heat. So, the usual questions arise: Is it Parkinson's? Is it aging? Is it my carbidopa-levodopa medication?

From July into early August, we had 13 consecutive days with sky-high humidity and temperatures 90+. During that spell, I left my air-conditioned house only when I could get right into an air-conditioned car. And I did that only to attend my senior bridge game and Parkinson's support group meeting. Back-porch time came only at breakfast.

The heat wave finally broke, and on Saturday I spent several hours enjoying the back porch. My housemates had invited some friends over later that afternoon for a cookout. So I decided the day presented a great opportunity to get out of the house, get some exercise, and do something fun.

But where to go? Someplace where I could have lunch, then take my usual after-lunch nap... then walk someplace interesting where I also could take breaks, reading and relaxing.

After 60 years living in Washington, I knew exactly where to go.

The National Gallery of Art
And I knew exactly what to do there.

August 7, 2015

To Limit Unnecessary Medical Risks and Dramatically Lower Healthcare Costs, Less is More

"Less is more" is my new mantra. I'm hoping it will result in briefer posts on this blog. Is that possible?

It would be absolutely fantastic if our healthcare professionals heeded the growing criticism of today's prevailing "More must be better" attitude. Luckily, momentum is growing for a "Less is more" approach to reduce unnecessary and potentially harmful "care."

In 2009, when the United States Preventive Service Task Force advised that mammography for women 40-50 probably does more harm than good, the reaction was hostile. What? More is better! Science be damned.

Our medical culture urges "Do everything possible," preferably with the highest level of available technology, even when the effort involves probable harm and little hope of benefit.

Less healthcare stirs fears of rationing... of withholding care to save money. Let's not forget that the vast healthcare machinery -- with doctors right there in the middle of it all -- earns more money with every additional treatment, operation, prescription. It's a powerful Machinery of More.

Signs of Change
There are signs of a shift. Several major medical journals have recently dedicated special sections that address the harms of overtreatment.

In April 2010, JAMA Internal Medicine launched such a "Less is more" series. To date, it has published over 170 related articles, including research reports, perspectives from patients and clinicians, and commentaries. Similarly, BMJ (originally the British Medical Journal) launched a "Too Much Medicine" campaign and sponsored a conference focusing on "preventing overdiagnosis."

Cost of Current Overtreatment
Researchers estimate that wasted healthcare dollars, including the pricetag from overuse of low value services, represent about a third of the nation's $2.8 billion healthcare bill. Even though America spends more healthcare money per person than any other nation, we rank LAST compared with 10 other high-income countries in infant mortality, mortality from conditions amenable to treatment, and healthy life expectancy at age 60.

August 6, 2015

Aging Well: the Ingrams Put Enjoying Life and Helping Others Ahead of Making Money

This post begins a series about people I know who seem to be aging well.

I start with my friends Daniel and Marione Ingram, who remind me that a continuing zest for life matters more than big bank account.

At my cereal and coffee this morning, I found that another post -- the Washington Post -- had beat me to it with a story about the Ingrams. The front page of the Style section featured an interview with Marione about her just-published book, The Hands of Peace, which chronicles her experience as an activist in the civil rights protests of the 1960s. This new book is a sequel to The Hands of War, her memoir about growing up Jewish in Nazi Germany, and surviving the Allies' firebombing of Hamburg.

The Ingrams and Me
My friendship with the Ingrams began in 1960 when Daniel left his job as an editor with Prentice Hall in New York City and came to Washington for a similar but better-paying job at the Bureau of National Affairs (BNA). I became managing editor of the unit where Daniel worked. He was easily the best writer on the staff. But sometimes I worried that BNA was losing out to the Newspaper Guild and CORE (the Congress on Racial Equality) in the competition for his time and attention.

Soon after a lengthy strike in 1966, Daniel left BNA to take a job with the United Planning Organization.

We lost track of one another, although I knew that he and Marione had bought a house in my Palisades neighborhood. I also knew they had a son Danny, but that was about it.

Happily, they reentered my life in 2007, and I learned their fascinating story.

August 5, 2015

My Life and My Blog: Sharpening the Focus

Now that I've decided that this year may not be my last, I'm asking a few questions. How will I manage my time ahead? How can I make the blog more meaningful?

Evolution of the Blog… And Me
I was belatedly diagnosed with Parkinson's disease (PD) in the fall of 2009, when I was 80. I started this blog the next year, giving it the title "Parkinson's and 5-HTP." Why? I had discovered that the serotonin booster 5-HTP was like a miracle remedy for several non-motor symptoms of PD, like depression and insomnia. Surely hundreds... thousands... (millions!) might benefit from my discovery.

Soon enough, after all my touting of the supplement, I discovered that the 5-HTP miracle was mine alone. But in the process, I also learned how much I enjoyed researching medical topics and writing the blog.

The more I wrote, the more I wondered if my own health issues were related to my PD, my aging, or both. So I changed the blog's title to "Aging and Parkinson's and Me."

August 4, 2015

Alzheimer’s Conference Update: The Negative Impact of Inactivity, TV Watching, and Loneliness on Seniors’ Cognition

The results of two studies presented last month at the Alzheimer’s Association International Conference in Washington, DC showed that inactivity, heavy TV watching, and loneliness raise one’s risk of developing dementia later in life. A July 20 article in The Washington Post reported the findings.

Inactivity, TV, and Dementia
Scientists at the Northern California Institute for Research and Education examined the physical activity and TV viewing habits of 3,247 adults who were 18 to 30 years when the study – known as the Coronary Artery Risk Development in Young Adults (CARDIA) -- began.

For the next 25 years, the researchers assessed their subjects’ exercise and TV habits three different times via questionnaires the participants completed.

For the purposes of the study, the California team defined low physical activity as “burning fewer than 300 calories in a 50-minute session three times a week.”

The researchers defined heavy TV watching as four or more hours a day.

If subjects met or exceeded those thresholds on two of the three follow-up sessions, they were considered to have long-term patterns of low activity levels or high TV watching. At the end of the 25-year assessment, 17 percent of all subjects fell into the low physical activity category, 11 percent were considered heavy TV viewers, and three percent fell into both categories.

Kristine Yaffe, a professor of psychiatry, neurology and epidemiology at the University of California in San Francisco, presented the conclusions at the Alzheimer’s conference. Among those results:
  • "Excessive" TV viewers were 1.5 more likely to perform worse on cognitive tests at midlife (ages 43-55, at the end of the study period) than participants who watched less television.
  • That three percent who exercised little AND watched lots of TV were two times more likely to perform poorly on cognitive tests at midlife than were those who exercised properly and watched little TV.

Yaffe said, “What’s happening at one’s midlife is setting the stage for what’s happening over the next 20 or 30 years.” She then mentioned that less than half the nation now meets recommended exercise standards.

Yaffe was quick to add that her team’s research also carried an upbeat message. A simple lifestyle change – more exercise, less TV – is likely to lower the risk of developing dementia later in life. “There is something you can do about it,” she said.

Loneliness and Dementia
Another study presented at the conference established a relationship between loneliness and dementia.