Written by Tena MooreLosing weight can be a very safe, and a very healthy endeavor; it all depends upon your method. If you need to lose weight for your health, there are healthy and safe ways to take the weight off successfully. The safest and most effective ways to lose weight are extremely simple and there is nothing ‘unsafe’ about them: Eat Less, Move More.Eat Less. Find out how many calories
Yearly Archives: 2009
What herbs or supplements are commonly used for depression?
There are many different herbs and supplements used for depression. One of the most notable and most studied is St. John’s wort. Countless clinical studies have found St. John’s wort as an effective treatment for depression, and doctors in Europe have been prescribing it for many years. You can find it at your local health food store as a tea, in a capsule, dried herb, or tincture. Many people
What do doctors think about vitamin E supplements?
Written by Tena Moore (- if this post appears on any site other than Vitaminstuff.com it has been stolen) On the topic of vitamin E supplements, it definitely depends on which doctor you talk to. The reason there is so much conflicting information about vitamin E supplements is due to conflicting studies, particularly in recent years when studies have indicated that Vitamin E megadosing can be
Thoughts on Dropping Weight
Written by Tim MooreHere's a post I recently made on facebook. It seemed relevant so I thought I would repost it here.I like krispy kremes but boy they put you on sugar overload, especially without the milk. My true fondness is things like stuffing, mashed potatoes, pizza, chicken-n-dumplings. I tried doing the low carb thing. And, yes, it does work. However, you feel so deprived that it doesn't
Regarding the Starting of a new diet regimen
Written by Tena Moore (- if this post appears on any site other than Vitaminstuff.com it has been stolen) Starting a new diet can be a stressful time. Changing how you eat, what you eat, and when you eat, can be challenging. Here are a few tips to remember to be more successful in this endeavor.Talk to a professional. First and foremost, talk to a professional about your new diet regimen. Find
Tips for eating in a vegetarian lifestyle
Vegetarians do not eat meat, fish or poultry. Whether you are thinking about adopting a vegetarian diet due to health reasons or environmental reasons, there are many things to think about to make sure that you are eating a diet full of vitamins and minerals, and not simply cutting meat out of your diet. Here are a few tips to keep you on the right track:Tip #1) Forgo junk foods like macaroni
The Gene Smart Diet
There's a great book out there called "The Gene Smart Diet". I would recommend it. It's written by a Professor of Pharmacology at Wake Forest University. I'm halfway through it and I think a lot of the eventual advice will boil down to adjusting one's diet to get more fruits and vegetables, more fiber, fewer empty calories, and also working in more exercise. That, of course, by itself doesn't
Quality of GNC Supplements
Recently I was wondering about the quality of GNC supplements so I went looking around on google and found this page. Why did I go looking at all? Well, I've read more than once that certain nutritional supplement products, after having been tested, have been found to contain less than what was advertised. My own suspicion is that this is more likely to occur when the price for a product is
Can Green Tea fight HIV infection?
This is amazing. The most notable ingredient of green tea, the compound EGCG, may help block SEVI and fight HIV infection.From the article itself, ""EGCG, a natural ingredient of green tea, may be a valuable and cost-efficient inhibitor of semen-mediated enhancement of virus infection, and hence of sexual transmission of HIV,"From this site: 1. EGCG seems to accomplish the remarkable feat of
What are some good fiber foods?
Some of the best foods for getting natural fiber into your daily diet are: 1) Banana's, 2) Apples, 3) Almonds, 4) Blackberries, 5) Raspberries, 6) whole wheat spaghetti 7) baked beans, 8) black beans. Of course, there are dozens of other choices. And many fruits and veggies that offer more fiber per serving. However, these just happen to be some of my own personal favorites. Of course, fruit is
Is There Evidence That Acupuncture Works?
Written by Tena MooreSome people think that acupuncture is a new-age healing method, not based on logical and proven medical and clinical evidence, but they may be wrong. New studies are emerging that seek to understand the relationship between acupuncture and health. As far as evidence is concerned, it may still be split down the middle 50/50 when it comes to proving that acupuncture can have a
What foods have both fiber and protein?
Written by Tena MooreFiber and protein are both crucial to a healthy diet. Incorporating foods into your diet that contain both can be a very healthy move, especially if you are a vegetarian or vegan, since you will not be getting any protein from animal sources. Animal proteins are not a complete fiber and protein food; they do not contain significant amounts of fiber, only plant sources contain
How good is fish for your diet?
Written by Tena MooreFish, especially fatty fish eaten in moderation, is excellent for anyone’s diet. While the term ‘fatty’ might make some cringe, these fish are the healthiest and tastiest of all fish, and are considered a great source of ‘good’, heart healthy fats. According to the American Dietetic Association, fatty fish to consume on a regular basis are: sardines, herring, tuna, trout,
Good Enough Science? Apparently so at 23andme
"A total of 61 individuals involved in five norovirus outbreaks in Denmark were genotyped at nucleotides 428 and 571 of the FUT2 gene, determining secretor status, i.e., the presence of ABH antigens in secretions and on mucosa. A strong correlation (P 0.003) was found between the secretor phenotype and symptomatic disease, extending previous knowledge and confirming that nonsense mutations in the FUT2 gene provide protection against symptomatic norovirus (GGII.4) infections."
This from a report at 23andSerge's "Norovirus Resistance" report.
I don't know what I would do with a Norovirus resistance report........Go on more cruises? Work in a daycare? Have more kids?
I bring this up because I begin to wonder what level of science is good science.
Is highlighting every article as useful as highlighting important and valid articles?
It seems to me that the best thing these companies can do is focus on good things and play a role in dispelling the not so good studies.
Heck, this is something I wanted to do on the Sherpa, but lack the resources....i.e the 13 million to burn on curators. So I select only the most relevant studies for PM and review.
I wonder if they (DTC Genomics) are just pulling up every study possible or if they are actively curating the data.
Because if they are curating, I wonder who is at the helm.
These are the studies they chose for the Norovirus report
Le Pendu et al. (2006) . “Mendelian resistance to human norovirus infections.” Semin Immunol 18(6):375-86.
Lindesmith et al. (2003) . “Human susceptibility and resistance to Norwalk virus infection.” Nat Med 9(5):548-53.
Hutson et al. (2005) . “Norwalk virus infection associates with secretor status genotyped from sera.” J Med Virol 77(1):116-20.
Kindberg et al. (2007) . “Host genetic resistance to symptomatic norovirus (GGII.4) infections in Denmark.” J Clin Microbiol 45(8):2720-2.
Thorven et al. (2005) . “A homozygous nonsense mutation (428G-->A) in the human secretor (FUT2) gene provides resistance to symptomatic norovirus (GGII) infections.” J Virol 79(24):15351-5.
Just from reading the abstracts not a single study had any number greater than 63 symptomatic patients.
Not a single study in my mind had statistical significance required for an association or a linkage study.
What in the hell is going on with the science?
If an apomediary is to be given free reign (Which I argue they should not in medicine), they better prove they are
1. An expert
2. Knowledgeable about the statistics required for the information presented
3. Not given false information, in science, non statistically valid information
4. Not a harm to the people they provide information to.
I think this is an example of a Big Fail here.
Yet they put it out from the rooftops, yelling on twitter, facebook, their blog, ALL OVER.
What in the hell is this information to be used for?
Even if for fun, it doesn't help if scientifically it is suspect. Isn't this what we bashed DNA Dynasty for? If this company wants to do right by people, they shouldn't boost the unimportant to the level of importance......
The biggest problem about this and other examples is the fact that the studies are not being vetted properly and the rushing to make a big deal out of suspect studies. This is analogous to the press publishing some crap study on the news. Which BTW, I have managed to tune out, because most of what they report is wrong. If they were a news organization, I would not be as pissed here, but they are not clearly just a reporting service, despite what SB 482 said.
23andSerge tests human biologic samples and gives diagnoses. As well as promotes unimpressive studies in an attempt to sell more tests......GREAT BIG FAIL!
The Sherpa Says: If this is the example of expert information that patients/customers can use to empower themselves, I would say they (Both 23andSerge and Customers) could do better reading the National Enquirer for health tips...
Change IS Needed. I agree with William, sometimes.
Over the past day or so I have been engaged with one of my fiercest critics. No a critic of me per se, but a critic of my opinions in the space of Personalized Medicine.
We may have a "truce", maybe......
William Gunn PhD is a pretty amazing guy and if you read his CV you can see he is very involved in the space and an excellent scientist.
Yesterday he and I exchanged emails and he posted a letter to the medical community. I think it is a great letter. He expresses some of the EXACT SAME frustration I have.
"I believe, as does pretty much everyone, that medicine is on the cusp of great changes and that personalized medicine holds great promise. I believe that an informed patient is an empowered patient, and ultimately a healthier one. Every good doctor should want this, and every below-average doctor should pray this day never comes."
I love his opening lines, but there are some problems that I see.
First let me state I agree with most of what he says, but:
1. There are a whole bunch of people who think personalized medicine is a pipe dream created while chilling with the caterpillar and Alice. Namely, doctors, scientists and politicians
2. I think most doctors try to help people, even the less than average ones. An empowered patent would be a benefit to them, but it depends on what the definition of empowered means.....
That is the major league difference between doctors and "super early adopters" in the DTC genomics space.
What is the difference?
The definition of empowered patient.
I have heard it described broadly such as
"Patient empowerment in the health care context means to promote autonomous self-regulation so that the individual’s potential for health and wellness is maximised."
This could be just about anything, including diagnosis and treatment. Which is interesting because in all states of the US you need a medical license to do that.
I also have heard it stated specifically in the Patients Bill of Rights as
"
The providing of information regarding therapeutic options so that a Patient can actively participate in the decision on whether to undergo a diagnostic or therapeutic procedure, or pursue alternatives." See Patient Bill of RightsThis is obviously more specific and falls in the realm of, you have a disease, now you can be empowered to actively participate in the discussion. I have always thought that if you don't have the terminology of medicine, this part puts you as a one legged man at an ass kicking contest.
The ideal place for patient empowerment is not sick in the hospital, by that time it is too late. You are sick and not likely to be able to learn as well as if you were healthy.
Which is why the empowerment piece should come in at the doctor's office or even at home in your underwear on your MacBook. I agree. I love when patients come in having read stuff. Just recently a patient came in knowing just about everything about a familial disease....the consult was super awesome and we had a great discussion. But again, this was a motivated subject.
But I ask, is that what the DTC Genomics coummunity thinks empowerment is? Is empowerment education? That is what the health community thinks.
But, William et.al. think it is more than that. They think it is access to biometric data AND interpretation of that. In some aspects, this could be considered education......
I agree, it is education of a sort. When it is from your doctor it is called good medical care.
But often it is through an Apomediary.
What's an apomediary? Well, 23andME considers themselves such.
even I consider myself an apomediary in things for which I am not licensed for (golf, start ups, etc). I.E. a self defined expert providing guidance to information about their "expert subject"
But for medicine, I am a licensed, board certified physician who has worked long and hard to stand by my expertise (8 years of work after my undergraduate work). Unlike DTC genomics companies, who are neither regulated, nor accredited to give expert medical opinion.
Thus, they are apomediaries. Is patient empowerment, unregulated access to apomediaries? Well, maybe. But I argue that DTC genomics are more than just Apomediaries.
They test human biologic samples and provide a diagnostic result, despite stating they are not providing diagnosis. Think BRCA carrier status here. Which BTW is a medical diagnosis. With a medical test.
So, is patient empowerment the ability to obtain diagnoses from a non licensed diagnostician?
I would argue that this is precisely what I am opposed to. This can lead to all sorts of danger. Last time I checked, laudanum was not FDA approved, nor were the apothecaries.......
The Sherpa Says: We have come a long way since then and going back there would put us squarely into the stone ages for quality of care. Which is why I am so vehemently against a company that tests your human biologic sample and provides a diagnosis without being licensed to do so. Change is Needed William, I agree.
Away and now back, What did I miss???? 23andme layoffs? Selling Genomes for cheap up next!
23andSerge has layoffs, big surprise.
When Linda left, she had a tribe that left too. I am working on hiring one or 2 and will see what exactly was going on over there......Likely a huge cash bleed
GAPPNet has their first meeting, which I missed.
I will email Dr. Khoury and find out how it went.
Daniel MacArthur pointing out that 23andSerge could have bashed bad science, yet instead promoted it......No surprise there either.
It looks like 23andSerge fired the engineers and scientists.....and kept the PR and marketing wonks.......
Well, in the end it is crystal clear
It turns out the lawyers questioned this as well as Misha.....Turns out, if you took the genome, then you probably can sell it.......better yet, if you "acquired it via firesale" you also can probably sell it and break all kinds of "terms of service"
What's important? Not having your genome sold off? What's important? Being able to be certain the person who has your information won't sell it to the highest bidder......Now do you see why it is important to have a doctor involved in this? We CAN'T sell it off. Even if we wanted to. It would be against the law......10 years in Folsom or 250,000 USD......OR BOTH!
The main problem is that a lot of people are confusing things.
What is important IS "What is important" not cocktail parties, blimps or CEO's from insurance companies
(hmmm, I wonder what Navigenics is thinking about doing with it's company?) Maybe Humana wants Navi, to profile their patients?
The Sherpa Says: Companies are most dangerous to their customers and the public when the chips are down. They often do unthinkable and crazy things........for cheap. Anything to survive, that is the motto of the startup. Do or should they have any loyalty to you, AFTER they already have your money? No, unless legally bound.....This is yet another reason why a doctor should be involved here.
Gluco…Wha? Parkinson’s Disease and Glucocerebrosidase mutations.
In 2007 I diagnosed a 74 year old woman with CF.
She had a positive sweat test and positive mutation with an intronic mutation as well.
I investigated this after she had bronchiectasis and no history of smoking. And a grandson with CF......... Why did I do the sweat test?
I needed to know if her bronchiectasis was due to CFTR mutations. Maybe she didn't need COPD treatment after all.
That same intellectual curiosity is found in a recent study in the NEJM. It turns out they are finding some patients who have Gaucher's also have Parkinson's Disease.
What's even more interesting is that Heterzygotes for Gaucher's are at increased risk of sporadic or familial Parkinson's disease. So one has to wonder, how many Parkinon's cases are due to GBA mutations.....
Well, this study aimed to elucidate that. First off, if the GBA mutations are higher than LRRK2, well, we my have another Ashkenazi Jewish disease.
What did these guys do?
5691 patients with Parkinson's disease (780 Ashkenazi Jews) and 4898 controls (387 Ashkenazi Jews) were analyzed, with multivariate logistic-regression models and the Mantel–Haenszel procedure used to estimate odds ratios across centers. Ok, a reasonable method.
Now what did they find?
This finding allows for confidence in reporting the Mantel–Haenszel combined odds ratios for N370S (odds ratio, 3.96; 95% confidence interval [CI], 2.60 to 6.02) and L444P (odds ratio, 6.73; 95% CI, 4.50 to 15.42). After correcting for outliers they can confidently report a Mantel–Haenszel odds ratio of 5.43 for GBA mutations, in patients versus controls Ok, so if you have either of these mutations, you are at a pretty high risk for Parkinson's Disease. Seriously. How many of the Parkinson's cases are due to this type of carrier mutation? Overall, when screening solely for N370S and L444P, one of these two mutations was found in 15% of Ashkenazi Jewish patients as compared with 3% of Ashkenazi Jewish controls and in 3% of non–Ashkenazi Jewish patients as compared with less than 1% of non–Ashkenazi Jewish controls That's a lot of cases.
Way more than the LRRK2 mutation Familial Autosomal Dominant disease that could be counseled by pedigree alone that Serge was so hepped up about.
But if you want a breakdown of LRRK2 versus GBA you can read about it here.
Of note, there are very few papers comparing both, but there is one that disproved my hypothesis that it is likely that the LRRK2's actually are GBA mutation carriers.... But 37 Families still gives me a little hope that Serge was focused on the WRONG gene...
Back to GBA mutation carriers, this like CF now has me asking "Does anyone in your family have a genetic disease like Gaucher's" when I see some PD history.
Which highlights a significant point, if Primary Care Doctors are supposed to perform family histories, then how in the hell are they supposed to know about this?
The answer: This NEJM article? Navigenics? Who? How?
Unfortunately, most Internists will look at the article and say "Meh, another one of those genetics articles I don't understand" Will giving each doctor a FREE Navigenics test break that attitude......doubtful.
The Sherpa Says: Geneticists need to do their job and teach other doctors, not serve on DTC genomics boards.
Did you get your kit? Thanks Dr. Rob from MedCo
I love and hate when GenomeWeb scoops me. I love it because I know someone else is out there assessing the field. But the competitive nature in me hates to be scooped......ah well, you can't win them all.
It turns out that Good 'Ol Dr. Rob and I agree, physician education is the key to get physicians involved in clinically important PGX testing.
Not only is education key, but maybe involving them in research about it may even be better.
A survey conducted by Dr. Rob's Team at MedCo and AMA just published at ASHG says so too.
"The survey, which was conducted in 2008, found that 13 percent of doctors had either ordered or recommended pharmacogenomic tests for their patients in the preceding six months"
That is about spot on as to what I told them about how many would be ordering tests immediately.
"There is a general lack of formalized pharmacogenomics training among physicians, the survey found, with 26 percent of respondents saying that they had received some form of education in the subject either in medical school or after graduation."
I taught pharmacogenomics to Yale and Yale Affiliated residents from 2007-09. I know that the ones who have learned are now actively looking up and interested in this stuff.
"98 percent of these physicians agreed that patient genetic profiles may influence drug therapy"
Obviously, they took pharmacology, the GET pharmacogenomics. It is not a big leap here!
"It's clear that there is wide acceptance that genetic testing has a role in patient care, but the need for formal training and education among physicians is necessary to obtain greater adoption and implementation of these tests in clinical practice. -Robert Epstein MD"
Precisely Dr. Rob, Precisely. No big surprise with the survey. But a big surprise in my mailbox......
Yes, a CYP2C19 study spit kit. MedCo is studying Effient vs Plavix with CYP2C19 testing, head to head.......
BooYah!! I just spoke with the Effient people the other day. They are keen on taking this market.
Now I just happen to be working on something that all of these interested and willing physicians will need.........
The Sherpa Says: Dr. Rob, I hope you are listening........It's time to execute.
Follow up to Yesterday’s WTF? Harvard, Navi? and Pfizer???
Yes, that is pretty freaking preposterous in and of itself, but I have a deeper concern.....
"Beth Israel has launched the Personalized Genomics and Next Generation Sequencing Training Program, which includes a series of lectures, discussions, and presentations, aimed at promoting a better understanding of the personalized genomics field and next-generation sequencing technologies."
Ok, so my question is. Who will be giving the lectures?
Let me put this another way.....
"NewsFlash" (This is not true, however it is just as preposterous and written to illustrate a point)
Harvard Medical School has agreed to partner with Pfizer to educate young resident physicians about pharmacology.
Residents will receive a series of lectures crafted by Pfizer to help physicians understand the complexities of pharmacology. To help the young physicians a pharmaceutical specialist employed by Pfizer will take the residents out to dinner and give lectures crafted by Pfizer.
To further enhance the training, all physicians will be given free samples of viagra/modafinil to help them understand how the medication works
"We believe that pharmacology and pharmacogenetics will be critical to the future of health care," Mark Boguski, of BIDMC's Department of Pathology and the Center for Biomedical Informatics at Harvard Medical School, said in a statement.
"Training our residents on the leading pharmaceutical services and technologies will be essential to this future."
(End Fake Story)
Do you get what I am saying yet, or are you such a blind supporter of DTC genomics to see the absolutely clear freaking conflict of interests here?
And for such a school which focuses so much on Conflicts of Interest, I am blown away that this program has not yet been shut down.....
You can email Mark Boguski at mark_boguski@hms.harvard.edu if you think this is as crazy as I do. Or maybe a phone call? 617-432-7375
The Sherpa Says: Do you see what I am getting at Mark? This is sketchy at best....
Excuse Me? Harvard and Navigenics? WTF?
Ok,
So I was blown away when I read this juicy little tid bit from Genome Web.
NEW YORK (GenomeWeb News) – Navigenics and Beth Israel Deaconess Medical Center in Boston announced today that they will collaborate on training physicians in personal genomic testing.
Amazing! I had spoken with Mike Murray up there a while ago and have neen involved in his training curriculum with CMEs for providers. I have always interpreted his opinion on the DTC companies to be suspect of what the hell the companies are doing.
In fact when we, Mike and I presented together at the Association of Program Directors in Internal Medicine meeting in 2008 in New Orleans I assumed that their department as well as he didn't much support DTC genomic testing.
Which is why the BID move had me puzzled, so I emailed him. But I also read further.....
As part of the program, residents will be given the opportunity to have their own genomes analyzed through Navigenics' consumer genomics services.
"We believe that genetics and genomics will be critical to the future of health care," Mark Boguski, of BIDMC's Department of Pathology and the Center for Biomedical Informatics at Harvard Medical School, said in a statement. "Training our residents on the leading genetic services and technologies will be essential to this future."
Ahh, I see. It is not the Genetics department who is involved with this. It is the pathologists, you know, the physicians who look at microscopic slides and run the clinical laboratories who are behind this.........
This Makes all the sense in the world now, non clinical geneticists teaching doctors about clinical genetics and how to use a self-avowed NONCLINICAL, NONMEDICAL test to learn medical genomics.....
What the hell is Harvard thinking? I wonder if they received a nice endowment gift from the VCs who fund Navi????
So let me get this straight, Harvard Medical School sponsored Medical Residency at Beth Israel Deaconess is using a NONCLINICALLY validated test, from a company who states that the test should NOT BE USED FOR MEDICINE, to teach MEDICAL residents. To quote the plan
"Among the specific goals of the program are fostering an understanding of issues related to the evaluation of direct-to-consumer genotyping services and familiarizing physicians with the interpretation of genomic information and its correlation with personal medical and health information."
Have they lost their minds???? Shouldn't this be something that the clinical genetics department should be teaching? I wonder if Vance received a faculty position for this horse$h!t?
The Sherpa Says: I knew that this wouldn't come from the clinical genetics side. I hope they don't have any fingerprints on this one.....But my guess is Raju is involved in this one some how.....Now Harvard is confusing what is Important.
