Is Caloric Restriction Necessary for Longevity? – Video

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Is Caloric Restriction Necessary for Longevity? - Video

A Biologist's Mother's Day Song – Video

I love you, mom Much to my surprise, some people have requested the mp3--now you can get it here: http://www.cdbaby.com (it's the first song) or on iTunes, just search cadamole Lyrics: To make one me you just add Half of mom and half of dad That is what I once believed But I know now that I was wrong I got so much more from you mom Than just half a set of genes I got nutrients and transcription factors and nearly everything that matters plus my prenatal environment (transplacental inheritance) mRNA, mitochondria, That back in the day once belonged to ya (theyre cytoplasmic) and I just want to thank for supplying them Just like two strands of DNA are spirally entwined Your nature and your nurture are inspiringly combined Scientists remind me and I find that it is true Slightly more than half of everything I am is thanks to you Mitochondria power my cells and they have DNA as well Transcription factors modulate transcription And since theyre in the cytoplasm The eggs the only one that has em and sperm I guess they dont have much ambition My sex determination gene means that Im a guy From you I got my X chromosome, from Dad I got my Y X has over a thousand genes, Y has less than 92 Thats why more than half of everything I am is thanks to you I roomed in your womb for nine whole months and never paid the rent Your glucocorticoids shaped my hypothalmic development I took in your blood and sucked it dry of every nutrient (its gross but true) Sometimes I wonder where the time went ...

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A Biologist's Mother's Day Song - Video

Longevity Science Would Benefit From a Carl Sagan Figure

Here's a question for you: why does the triumvirate of astrophysics, astronomy, and cosmology get such good press and widespread public approval in comparison to, say, the fundamental life sciences? I have to think it has something to do with the succession of scientists who evolved into successful media figures, educators, and advocates for their field, such as Carl Sagan, the present day Neil deGrass Tyson, or Patrick Moore - and I'm probably dating myself here by knowing of the existence of the latter. If asked to name noted scientists who went on to become media figures, off the cuff, I think I'd be hard pressed to quickly come up with more than one or two who didn't come from an astrophysical or similar background (right now my brain is delivering Attenborough, Dawkins, and blank). So clearly there's been a lot of groundwork accomplished over the past decades: bringing the broad field of physics and cosmology to the masses, and along the way gaining public support for the ongoing and often thankless work of understanding the universe and its myriad components.

A cynic might think that that having a massive government agency like NASA floating around for a good number of decades and spending lavishly on flashy programs intended in part to assure its own popularity might have something to do with it. I'd be that cynic, but it seems to me that most of the comparatively less popular and less beloved fields of scientific research are also ridden by large government agencies in the US - big budgets and just as much need for popular support. So I do think that there's something interesting going on here in that small sliver of the media spectrum that scientists have colonized. Something we can learn from.

To be a media figure of this sort is a career path option that's certainly open to researchers who garner either sufficient fame or media experience across the years, but for best effect it requires you to remove yourself from the business of science. The scientific community tends to behave like an aggravated immune system when confronted with someone who is both a media figure and actively publishing scientific research. Throughout history a great many people have subverted the scientific method for personal gain, using influence, fame, money, and other forms of corruption - and the modern media is all that rolled up into one neat package. Taking your work to the press before taking it to your peers is thus a grand heresy in modern science, one which leads to harsh judgement and excommunication. Consider what happened to the reputations of Pons and Fleischmann, for example. From that, all things associated with the mass media come to be eyed with suspicion by the rank and file scientists: publicizing a field is very welcome, but even the slightest hint of use of position to influence matters of publication is going to stir up wrathful mutterings at the very least.

So the scientist turned media figure must feel strongly enough about his field to want to be an advocate and educator, but must also essentially give up his work in favor of talking about what he used to do. Not, I think, the easiest of paths for someone who truly enjoys the scientific life.

Regardless, the future of longevity science - or the foundations of rejuvenation biotechnology, or SENS-like research, or whatever you want to call it - must come to include scientist-educators in the media. A Carl Sagan for this presently minor field must eventually arise: to my mind that will be one of the signs of growth and progress, meaning that it will happen as a matter of course along with (a) the expansion of the community of researchers actively working on ways to repair the damage of aging, and (b) increasing public awareness. But sooner is always better than later.

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

The Culture and Practice of Science is Changing

The opening up of information, communication, and organization brought by the internet is changing business as normal in every field, making it far easier for ideas on the edge to gain support and activity. This is important for the development of rejuvenation biotechnology, as the changing nature of scientific work can speed the move to the mainstream, and allow for far more useful progress to be achieved while the flow of funding is still comparatively small: "our entire model of education and what it means to be a 'trained professional' is shifting. There's a hell of a lot of resistance from the status quo - which makes it difficult and inconvenient for rapid progress - but it isn't enough to stop it from happening. ... When the university system and the current PhD paradigm was invented, it was a different time. ... If you wanted to study advanced topics, or apprentice under someone famous to learn from their expertise, you needed to go to a university. But things are different now. Technology allows us access to some of the leading minds of our age [making] proximity to a university campus nearly irrelevant in order to meet other students and benefit from valuable peer-to-peer discussions. With the world's information available on the web, and with all of these advances in technology allowing for rapid data sharing and collaboration, how much value is there in the Ivory Tower? We are becoming a society of autodidacts, with information at our fingertips 24/7. Citizen Science is a natural consequence of that. Have an interesting scientific inquiry? Get on the web and investigate it. Learn from the millions of sources out there. Crowdsource some ideas, generate some hypotheses. Have discussions with others. Make a plan. Get your equipment. The scientific method is in-progress. Science is free for all to explore. Why waste time jumping through bureaucratic hoops when you can begin investigating what you want, when you want? Need to fund your research? Crowdsourced methods of funding, such as Kickstarter, are becoming more popular for these types of endeavors. Instead of 100 scientists chasing the same grant, why not go to the public and let them fund what they think is valuable? I think we'll be seeing a lot more of this in the future."

Link: http://ieet.org/index.php/IEET/more/4935

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

A Review of 100+ at h+ Magazine

Another review of Sonia Arrison's 100+: "I have to congratulate Sonia Arrison on putting together a book that is both highly accessible to newbies with no prior background in transhumanist thinking or longevity research, and also richly interesting to those of us who have playing in these regions of conceptual space for a long time. The main concepts in the book are indeed things I've been familiar with for a long time: (a) There is a host of rapidly accelerating technologies with the apparent capability of dramatically extending human healthspan, (b) Most likely, human psychology and society will adapt to dramatically increased human healthspan as it occurs, so that it will be experienced primarily as a Good Thing rather than as something traumatic or troublesome However, the book is packed with a sufficient number of interesting informational tidbits, that I found it well worth reading in spite of my general familiarity with the biology, psychology and sociology of radical longevity. ... Arrison reviews the key technological streams leading us toward radically increased healthspan - including gene therapy, stem cell therapy, Aubrey de Grey's SENS concept, artificial organs, tissue regeneration, the potential application of advanced AI to longevity research, and so forth. Both current research and envisioned future advances are considered. Then, in what is probably the greatest strength of the book, she considers the potential psychological and social impact of progressively increasing healthspan: the effects, as the book's subtitle indicates, on personal life, family relationships, marriage, careers and the economy etc. Combining common sense with appropriate invocations of rigorous research and statistics, Arrison provides the most systematic refutations I've seen of the standard anti-longevity arguments - 'death gives life meaning', 'overpopulation will starve or bankrupt us all', and so forth. Step by step, and in an invariably good-natured and friendly way, she demolishes these arguments, making a solid case that increased healthspan is likely improve rather than degrade our emotional health and family lives and enhance our careers and economies."

Link: http://hplusmagazine.com/2011/10/26/sonia-arrisons-100-plus-book-review/

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

An Introduction to Cancer Stem Cells

The cancer stem cell hypothesis suggests that a majority of cancers are driven and supported by a small population of errant stem cells, and that these cells are characteristic in ways allowing them to be identified and destroyed. Without the cancer stem cells, a cancer would whither. In other words, cancer stem cells offer the hope that there are in fact broad commonalities in the mechanisms of different forms of cancer, and that this fact will lead to a unified, single technology platform and robust cures for even late-stage cancers.

The existence and universality of cancer stem cells is a hotly debated topic in medical research, and rightly so for the reasons given above. Good evidence and arguments can be found on either side. Is cancer something that can be solved through a single mechanism or group of very similar mechanisms? Or only some cancers? Or only few cancers? These are important questions, and the answers, when they arrive, will tell us whether the prospects are for many cures arriving soon or for a slow and incremental flow of therapies over decades.

Today I noticed a good introductory popular science article that walks through the present state of research and scientific thought on this topic, and provides copious references along the way. You might find it interesting:

Take some cells from a tough-to-treat tumor, sort them, and inject each fraction into a different immunodeficient mouse, and only a small percentage of those cells will thrive and form tumors. This sort of experiment illustrates a concept that has been gaining traction within the cancer research community. Tumors contain a diverse mixture of cells, and only a handful of them can bounce back after treatment. That deadly minority can reproduce indefinitely and differentiate into a wide variety of cell types, just like stem cells. And often they express many of the same genes that are active in induced or embryonic stem cells and inactive in mature tissue.

...

The logic of pursuing therapies that might zero in on cancer stem cells is compelling to many. But the methods to evaluate such therapies' effectiveness, or to personalize cancer treatments according to stem cell markers, are not nearly as well developed. Without an array of proper markers, it's hard to tell whether drugs that target cancer stem cells are working as intended. ... Things are looking up for genetic analysis, but the poor reliability of cancer stem-cell-surface markers remains a confounding problem. For nearly a decade, biologists have known that antigens such as CD133 can be found on the surfaces of cancer stem cells. But these markers are not particularly specific.

...

But for solid tumors, which account for about 85% of all cancer diagnoses, the search for such stem-cell-surface markers is still in the early days. In such [cancers] cell-surface markers can vary from one type of cancer to another or even from one cell within a tumor to another. Until better markers are discovered [the] cancer stem cell field will remain somewhat embryonic.

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

More Work on Epigenetic Age Determination

A number of different research teams have recently demonstrated epigenetic markers that can be used to establish chronological age or predict life expectancy to various degrees. Here is another: "Aging has been associated with accumulation of cellular defects such as DNA damage and telomere shortening. On the other hand, there is accumulating evidence that aging rather resembles a developmentally regulated process which is tightly controlled by specific epigenetic modifications. ... All tissues of the organism are affected by aging. This process is associated with epigenetic modifications such as methylation changes at specific cytosine residues in the DNA (CpG sites). Here, we have identified an Epigenetic-Aging-Signature which is applicable for many tissues to predict donor age. ... This Epigenetic-Aging-Signature was tested on a validation group of eight independent datasets corresponding to several cell types from different tissues. ... The average absolute difference between predicted and real chronological age was about 11 years. ... It has to be noted, that chronological age is not identical with biological age and it is conceivable that some of the discrepancy between predicted and real age can be attributed to this difference - further research might facilitate determination of the biological age for personalized medicine."

Link: http://impactaging.com/papers/v3/n10/full/100395.html

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

Speculating on the Timeline for Artificial Blood

There are a number of different lines of research focused on developing artificial blood or culturing blood to order from stem cells: "Clinical trials using blood created from adult stem cells are set to begin within the next two or three years, raising the prospect it could soon become routinely used where real blood is unavailable. Scientists are also developing alternative bloodlike substances which could be injected into the body as a 'stopgap' until an actual blood transfusion could be performed. ... modern doctors have minimised the risk of patients receiving infections such as Hepatitis A and C during transmission [but] blood produced from stem cells would avoid these risks and could be manufactured as type 'O-negative', which is produced by just 7 per cent of the population but is suitable for use in into up to 98 per cent of patients. ... It could also be used in certain hospital situations, for example in elective surgery, and save hundreds of thousands of lives in parts of the world where blood banks are not available. [Researchers have] developed a method of taking adult stem cells from bone marrow and growing them in the laboratory to produce cells which look and act almost identically to red blood cells. Once their technique is fine-tuned the team may consider using stem cells taken from embryos, or reprogrammed skin cells, instead of adult cells because although the end product does not mimic red blood as closely, they can be grown in much greater quantities in the lab. ... A more radical solution, which [researchers] say could be perfected within five to 10 years, is to develop a completely artificial alternative to blood which performs the same key functions and would be safe to use in patients of every blood type. This could involve packing haemoglobin - which carries oxygen around the body - into a synthetic cell-like structure, or using a chemical to hold the haemoglobin together so that it can be injected without the need for red blood cells."

Link: http://www.telegraph.co.uk/science/science-news/8850684/Artificial-blood-could-be-used-within-next-decade.html

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

Aubrey de Grey at the MIT Club of Northern California

SENS Foundation co-founder Aubrey de Grey recently presented at a meeting of the MIT Club of Northern California, and a two-part video record of the event was uploaded for those of us too distant in time and space to be there:

Join us for a fascinating discussion with Dr. Aubrey de Grey, Chief Science officer of the SENS Foundation (SENS stands for "Strategies for Engineered Negligible Senscence"), on the topic of "Regenerative Medicine Against Aging."

Dr. de Grey has been a provocative and polarizing figure in the scientific and medical communities' dialogue on the topic of life extension, and the approaches that will
lead to dramatic increases in quantity and quality of life.

According to Dr. de Grey, "the first human who will live up to 1,000 years is probably already alive now, and might even be today between 50 and 60 years old."

You might look back into the archives for an explanation of the 1,000 year life span: this is an estimated life expectancy for someone who does not age to death, thanks to a rolling series of advances in rejuvenation medicine that eventually add more than a year of additional life with each passing year of research and development. If you examine mortality rates due to other causes projected out over time, you see that an effectively ageless person will live for at least a millennium under the mortality rates of today, not considering any future reductions in the rate of death by accident thanks to advances across the board in technology.

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

Keeping an Eye on Amyloid Vaccine Development

The SENS Foundation has published a series of posts over the past year or so that follow progress in the development of immunotherapies to remove the age-related buildup of amyloid in the brain - much of it intended as treatments for Alzheimer's disease. Success here will, however, lead to a broader technology platform that might ultimately be turned against any damaging aggregate that builds up in the body with age. These aggregates contribute to aging itself, and so removing them is one necessary part of any comprehensive rejuvenation biotechnology package: "soluble and insoluble aggregates of beta-amyloid protein (Aß) and other malformed proteins accumulate in brain aging and neurodegenerative disease, leading progressively to neuronal dysfunction and/or loss. These have long been widely accepted to be drivers of Alzheimer's disease (AD) and other age-related dementias and neurological disorders such as Parkinson's disease, and it has recently become increasingly clear that neuronal protein aggregates are the main driver of 'normal' cognitive aging. To prevent and reverse the course of neurodegenerative disease and age-related cognitive dysfunction, the regenerative engineering solution is therapeutic clearance of extracellular aggregates (such as Aß plaques) and intracellular aggregates (such as soluble, oligomeric Aß). Immunotherapeutic Aß clearance from the brain is a very active field of Alzheimer's research, with at least seven passive, and several second-generation active, Aß vaccines currently in human clinical trials. ... . We now have a published report of preliminary findings from the first Phase I trial in an Aß-targeting vaccine with novel properties, and with the benefit of preliminary findings of outcomes that have only emerged with the experience of its forerunners in previous clinical trials."

Link: http://sens.org/node/2437

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

Correlating Immune System State With Health in Old Age

Via ScienceDaily: "Exceptional cognitive and physical function in old age leaves a tell-tale immunologic fingerprint, say researchers ... Likewise, older adults who have mild impairments bear a distinct immunologic pattern, too. ... Our study indicates that getting older does not necessarily mean that the immune system gets weaker, as many of us assumed. The immune system is dynamic, and the changes it undergoes over time very much influence function. ... For the project, the team collected blood samples from 140 participants who had been followed in the Cardiovascular Health Study (CHS) for nearly two decades and were 78 to 94 years old. With only two participants younger than 82, the average age of the group was 86. The team also gathered information about the participants' health and function, medical history and hospitalizations, and self-rated health, and assessed their cognitive and physical function using standard tests. Previous research has shown that with age, immune cells called T-cells become more like natural killer (NK) cells, which typically target tumor cells and virus-infected cells ... A closer look in the new study shows that participants who were most physically and cognitively resilient had a dominant pattern of stimulatory NK receptors on the T-cell surface, and that these unusual T-cells can be activated directly through these NK receptors independently of the conventional ones. The functionally resilient elders also have a distinct profile of blood proteins called cytokines that reflect an immune-enhancing environment. ... Conversely, the group that showed mild health impairment had a dominant pattern of inhibitory NK receptors on their T-cells, and they have a cytokine profile indicating a pro-inflammatory environment. Both of these immunologic features could suggest a greater susceptibility to illness."

Link: http://www.sciencedaily.com/releases/2011/10/111021125808.htm

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

Surgeries are not a Desirable Goal for Rejuvenation Therapies

The present work on tissue engineering of large structures, such as printing blood vessels and organs, or creating patient-specific organs for transplant using decellularization, will produce end results that rely on surgery - major surgical procedures in the case of organ transplants.

The trouble with surgery is that it is risky: major, involved surgeries bear a non-trivial risk of death even in the most advanced clinical surroundings, and that risk grows with age. Old people suffer a general frailty due to the damage of aging that makes it progressively less likely for them to survive any given surgical procedure. When you consider that every major organ is going to have issues if we live long enough without access to general biological repair technologies that remove the cellular and molecular damage that lies at the root of tissue dysfunction in aging, that's a bunch of major surgeries to look forward to.

So I believe we should look on the forthcoming phase of tissue engineering as a transitional period: organs will be built from scratch and transplanted until such time as the state of the art allows our existing organs to be incrementally repaired and rebuilt in situ instead. Eliminating the need for surgery is a big deal, and so in the long term I think that the future belongs to the branch of regenerative medicine that delivers populations of tailored stem cells into damaged tissue. As the research community becomes every better at precisely controlling the behavior and activities of cells, even that step of delivering new cells into the body may go away, to be replaced with adaptive drug-like therapies that issue commands to the body's existing cells through signaling pathways or induced epigenetic alterations, and which react to guide the ongoing state of repair.

Either way, surgery is not a desirable outcome - it's a least worst path at the best of times. In the future of medicine and aging, everything that can be achieved without surgery should be achieved without surgery, and we'll all be better off for it.

Source:
http://www.longevitymeme.org/newsletter/latest_rss_feed.cfm

Treatment of Depression More Than Triples in the US Over the

Treatment of Depression More Than Triples in the US Over the Last 10 Years

Among people receiving treatment for depression in the US, the percentage of those on antidepressant medication has risen dramatically, while fewer are opting for time on the couch in psychotherapy.

The number of Americans treated for depression soared from 1.7 million to 6.3 million between 1987 and 1997, and the proportion of those receiving antidepressants doubled.

The researchers attributed the sharp increases to the emergence of aggressively marketed new drugs like Prozac, the rise in managed care and an easing of the stigma attached to the disease.

The study found that the share of patients who used antidepressant medication climbed from 37% to nearly 75%. At the same time, the proportion who received psychotherapy declined from 71% to 60%.

The publicizing of newer antidepressants that have fewer side effects - such as Prozac, which was introduced in late 1987 - has helped make patients more willing to seek treatment, the researchers said. This publicity has included pharmaceutical industry efforts to market the drugs directly to consumers and public-awareness campaigns about depression. Read more...

Ayurtox for Body Detoxification

Source:
http://feeds.feedburner.com/integratedmedicine

Chocolate consumption is inversely associated with coronary heart disease

Cocoa and dark chocolate are rich in flavonoids and may lower blood pressure.

5,000 people aged 25-93 years participated in the National Heart, Lung, and Blood Institute (NHLBI) Family Heart Study.

Compared to subjects who did not report any chocolate intake, odds ratios for coronary heart disease (CHD) were:

- 1.0 for subjects consuming chocolate 1-3 times/month
- 0.74 for subjects consuming chocolate 1-4 times/week
- 0.43 for subjects consuming chocolate 5+ times/week

Consumption of non-chocolate candy was associated with a 49% higher prevalence of CHD comparing 5+/week vs. none per week [OR = 1.49].

Consumption of chocolate is inversely related with prevalent CHD in a general United States population.

References:

Chocolate consumption is inversely associated with prevalent coronary heart disease: the National Heart, Lung, and Blood Institute Family Heart Study. Djoussé L, Hopkins PN, North KE, Pankow JS, Arnett DK, Ellison RC. Clin Nutr. 2011 Apr;30(2):182-7. Epub 2010 Sep 19.
Image source: Wikipedia, public domain.

From Writer's Almanac:

Ode to Chocolate by Barbara Crooker (excerpt)

I hate milk chocolate, don't want clouds
of cream diluting the dark night sky,
don't want pralines or raisins, rubble
in this smooth plateau. I like my coffee
black, my beer from Germany, wine
from Burgundy, the darker, the better.

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Don’t just swallow, check the evidence first – it applies to diet, medications, and more

The wrong approach

According to the food conglomerate Danon: “Evidence is increasing that even mild dehydration plays a role in the development of various diseases.” It’s a campaign, sponsored by the producers of Volvic, Evian, and Badoit bottled waters, to get us all to drink more water.

But what and where is this evidence? A doctor replies: “This is not only nonsense, but is thoroughly debunked nonsense.”

The right approach

Worried by the fact that European guidelines classified almost all older people as being at high risk of cardiovascular disease, Norway has developed its own guidelines that use differential risk thresholds according to age.

Compared with the European guidelines, the total sum of life gained is about the same, but the number of patients treated is considerably lower.

How does clinical evidence work?

Ben Goldacre's Moment of Genius on BBC4 radio:

"Clinical trials in medicine are designed to be free from bias. They test, as objectively as possible, the effectiveness of a particular intervention.
When you bring the results of all these individual trials together, however, how do you weigh up what evidence is relevant and what is not? In 1993, a method of "systematic review" was introduced that enables us to get the clearest possible view of the evidence."

References:

Don’t just swallow, check the evidence first. Godlee 343. BMJ, 2011.

Image source: Plastic bottles before processing. Wikipedia, dierk schaefer, Creative Commons Attribution 2.0 License.

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Interesting Correlation: Fast Food Founders and Longevity

Jay Parkinson noted an interesting correlation between Fast Food Founders and Longevity:

- Ray Kroc (McDonald’s) died at age 82

- Jimmy Dean died at age 81

- Taco Bell founder Glen Bell died at 86

- Sonic founder Troy Smith died at 87

- Hardee’s founder Wilber Hardee died at 89

- Baskin-Robbins founder Irvine Robbins died at 90

- Carl’s Jr. founder Carl Karcher died at 90

- Frozen french fry mogul J.R. Simplot died at 99

- Murray Handwerker, credited with making Nathan’s Famous Hot Dogs into a well-known national chain, died at 89

"Fake foods are more affordable. It's enticing people to eat more because they think they're saving money when they're really just buying heart disease." 10 Questions for Jillian Michaels. TIME, 2010.

Comments from Google Plus (Jul 27, 2011):

Maf Lewis - I'm going to guess that most of them were American, rich and therefor some of the few that could get good healthcare in the USA.

Neil Mehta - Good point +Maf Lewis
In addition they probably did not eat the fare their restaurants dished out?

Ves Dimov - I would assume they didn't eat the items on their restaurants' menu regularly.

One McDonald's CEO was famous for eating at least one product of its company daily. Unfortunately, he died at 44, from metastatic colon cancer. This does not prove causation, of course.

http://en.wikipedia.org/wiki/Charlie_Bell

Mr Bell oversaw McDonald's "I'm lovin' it" advertising campaign and introduced successes such as McCafe.

http://news.bbc.co.uk/2/hi/business/4180627.stm

Robert Silge - +Maf Lewis They clearly were both rich and American, and we could add male and white, but stating that they are among the "few" that could get good healthcare is grossly overstating it.

Maf Lewis - +Robert Silge As there are around 25%-30% uninsured Americans and another 20%-30% who have significant restrictions on their health insurance, I would say that Americans that get good healthcare (as compared to other countries of similar wealth per capita) would be in the minority - hence the few. Even if my figure are way off, the difference between health care of the top few % in the USA and the rest is enormous.

Robert Silge - +Maf Lewis Define "significant restrictions". Every system of organized healthcare has significant restrictions on how you can get healthcare. A complete lack of restrictions would be unfettered capitalism, where you can get whatever you want if you can pay for it.

Look at the literature. There is an association between socioeconomic status and longevity in any society. It is admittedly more pronounced in the US than in some countries. Some western countries are worse still.

Ves Dimov - Lifespan and social status: Why your boss will probably live longer than you
http://goo.gl/DQJRR

Maf Lewis - +Robert Silge - I agree it's hard to define and be accurate with some of these points, but for me significant restrictions would mean that you have a limit by the amount insurance will pay out for a specific illness, or pre-existing conditions, or other small print such as your activities are deemed dangerous sports (climbing on a roof to fix and ariel), or even having insurance investigators look into your case to see if there is a loophole that will enable them to not fund treatment- something I and my family came across first hand in my 6 years living in the USA.

I would confidently say that general healthcare in the USA is substandard to that of France, UK, Germany, Australia New Zealand etc, but for the top few % it is possibly the best in the world... actually it's best for the top few % in any country who can go anywhere in the world and get anything done...

The USA has the highest standard of living but one of the lowest life expectancies of the top 10 richest (per capita) countries.. why? Healthcare.

Maf Lewis - I absolutely agree about social status/health in all countries. I think it's just a bigger gap in the USA, as with educations, income, everything.

Robert Silge - Yes, it is bigger in the USA than in other countries. This article is horribly out of date (as in, it looks at WEST Germany), so take it for what it's worth, but the relationship between income and lifespan was least pronounced in Sweden and Norway, worst in the US and UK (and W. Germany, but let's ignore that all together). http://www.bmj.com/content/304/6820/165.full.pdf

Are there more uninsured and under-insured than I would like? Absolutely. But I think you're looking at this upside down. Our ability to take care of the bottom of our society is undeniably poor. But the middle elements of society get good care. And I'm not even saying that this is the way things ought to be. But it's the way things are, and to say a minority of patients get good healthcare is inaccurate to me. I would fundamentally disagree that FEW people in the US get "good healthcare".

Maf Lewis - Ok, all good points Robert. Maybe if I said that the average person in the USA doesn't get as good health care as the top 10 richest countries (per capita)?

Maybe I'm bias because of my direct experience with health care in the USA (6 years), Australia (1 year), UK (30 years), France (on and off 20 years). Always the USA was more limited and slower.

Robert Silge - Well you certainly have more direct experience than I, and no one can argue with that. I think it would be accurate to say that the highs are higher and the lows are lower in the US. That probably applies to a whole host of aspects of life here. For better or worse it's what we do.

Maf Lewis - True, but my direct experience could a series of both good and bag luck;) I'm sure there are horror and hero stories in all counties.

Yes I think the extreme highs and lows do apply to most things, and in a weird way it's both the worst and also the best of the USA.

Maf Lewis - Just to make it clear (if I hadn't already) it's not the health care professionals in the USA that are the problem here, but the insurance industry, and healthcare for profit in general.

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Social media in medicine: How to be a Twitter superstar and help your patients and your practice

This is the key concept of a series of talks that I am scheduled to present at several national and international meetings in 2011-2012 (AAAAI and WAO):

- Cycle of Patient Education
- Cycle of Online Information and Physician Education

The two cycles work together as two interlocking cogwheels.

Cycle of Patient Education (click here to enlarge the image).

Cycle of Online Information and Physician Education (click here to enlarge the image).

The first presentation was during the annual meeting of the Canadian Society of Allergy and Clinical Immunology (CSACI) and brought a lot of engaged, useful, and interesting questions. Feel free to use the images in your own presentations with credit to AllergyCases.org.

Byproducts of the Cycle of Patient Education

- Energy! (energized and engaged patients)
- Improved understanding of patient's condition, outcomes and quality of life
- Better physician-patient relationship
- Increased referrals to the practice, e.g. 2-5 new patients per week
- Savings for the health system
- Decreased ER visits and admissions

What is Return On Investment (ROI) of Cycle of Patient Education?

Calculated ROI:


- 2 new patients per week who come to the clinic directly from the blog/Twitter account
- $500 reimbursement for 2-3 visits (initial visit and 1-2 followup visits)
- 50 weeks x 2 patients = 100 new patients per year
- 100 patients x $500 = $50,000 per year

The best interest of the patient is the only interest to be considered

The purpose of the cycle is not to make money. As the Mayo Clinic CEO pointed out recently, Mayo Clinic intends to be the leader in social media in healthcare but this is not about competitive advantage, it is about the patient. The best interest of the patient is the only interest to be considered. Social media makes the union of forces more broadly practical than at any time in human history.

Social media for physicians: Do I really need to be on Twitter, Facebook and YouTube?

(the text below uses the specialty of allergy and immunology as an example, an edited version was published on the website of the World Allergy Organization where I write a monthly column)

It certainly looks like social media is taking over the world. Facebook is a “country” with more than 750 millions citizens. Twitter has more than 250 millions users. Google+ is the fastest growing web service and history and reached 25 million users in just one month after its launch. As an allergist, you may ask yourself, “Where is my place in all this? Do I have to be on Twitter? Do I have to use Facebook and YouTube to stay relevant?” The answer is yes.

Social media can provide a focused and time-efficient learning experience. Sharing relevant medical news with patients is just a click away. The paramount is to protect patient privacy at all times and to comply with your employer and professional organization guidelines. You can be a physician and a social media superstar at the same time. Here is how in 3 easy steps.

1. Use of Internet to learn and stay up-to-date

- Web feeds (RSS and Atom) work great for for targeted updates from journals, websites, and allergy/immunology news. RSS stands for Really Simple Syndication and consists of updates pulled from a particular website whenever something new is published. RSS feeds can be separated in different categories, e.g. asthma, allergic rhinitis, etc. Web-based RSS readers (Google Reader, Feedly, Flipboard) function as “inbox for the web”. You can get all sources delivered in one location - a web-based reader

- Blogs and Twitter accounts. A selected list of high-yield blogs and Twitter accounts of board-certified allergists/immunologists includes: @JuanCIvancevich (Juan C. Ivancevich, Buenos Aires, Web Editor of the World Allergy Organization), @wheezemd (Michael Blaiss, MD, Past President of the American College of Allergy, Asthma, and Immunology), @DrSilge (Robert Silge, MD, allergist/immunologist, Salt Lake City, Utah),
@AllergyNet ( John Weiner, allergist, clinical immunologist, Melbourne, Australia), @MatthewBowdish (Matthew Bowdish MD, allergist/clinical immunologist, Colorado), @allergydoc4kidz (Stuart Carr, allergist/immunologist, Canada), and the author’s own Twitter account at @Allergy.

- Podcasts for allergy and immunology education represent mobile-based MP3 files and services with automatic subscription. Free podcasts/videocasts are provided by COLA Allergy (ACAAI, http://childrensmercy.org/content/view.aspx?id=5979), Journal of Allergy and Clinical Immunology (AAAAI, http://jacionline.org/content/podcast), and World Allergy Organization (http://journals.lww.com/waojournal/Pages/podcasts.aspx).

- Persistent searches for topics of interests in allergy/immunology. You can subscribe to RSS feeds for "persistent searches" in PubMed and Google News for the topic of your interest, e.g. “oral immunotherapy for food allergy”.

- Text-to-speech (TTS). You can use text-to-speech to listen to journal articles at a later time. The text-to-speech programs convert the the text of a journal article into an MP3 file. A free program is Balabolka (http://cross-plus-a.com/balabolka.htm).

- Clinical cases and practical questions are available from the World Allergy Organization Journal, AllergyCases.org (disclaimer: the author is the founder of the website), AAAAI Ask the Expert (http://aaaai.org/ask-the-expert.aspx).

2. Use of Internet and computers for patient education

- Patient education diagrams - web- and iPad/tablet-based diagrams are well-received by patients and doctors in training. The the author's survey at the allergy clinic of the University of Chicago showed a 95% patient approval rate for iPad use for patient education. The diagrams used in the study are available here: Diagrams for Patient Education.

- Videos for patient education can be viewed on tablet or netbook. The videos can be streatmed from the physician's website or downloaded locally. Targeted videos can be used for patient education before and during the visit, for example, “what to expect from your visit at the allergist office”, “how to use an inhaler”, etc. There is a continuum of education - start at the office (tablet or netbook), then continue at home (web-based videos and selected educational brochures and links).

- Ready-made patient education brochures can be printed from allergist's website. A custom-made search engine can generate brochures on demand, e.g. Medline Plus.

3. Use of Internet to promote your practice and collaborate

- Start a website for free (WordPress.com or Blogger.com). Start a Twitter account and professional Facebook page for your practice.

- Setup persistent searches for your name/practice on Google, Twitter, etc. and subscribe to RSS for automatic updates. You can address questions and concerns whenever they arise.

- Use Google Docs for research collaboration, creating diagrams for patient education, office calendar, and spreadsheets.

Risks of social media use by physicians

Physicians must maintain appropriate boundaries of the patient-physician relationship in accordance with professional ethical guidelines just as they would in any other context. When physicians see content posted by colleagues that appears unprofessional they have a responsibility to bring that content first to the attention of the individual, so that he or she can remove it and/or take other appropriate actions. If the behavior significantly violates professional norms and the individual does not take appropriate action to resolve the situation, the physician should report the matter to appropriate authorities (Source: AMA Policy: Professionalism in the Use of Social Media, 2011).

Advice for Physician Who Use Social Media for Professional Purposes
- Write as if your boss and your patients are reading your blog every day
- Comply with HIPAA, e.g. never publish any identifiable information without patient permission
- Consider using your name and credentials on your blog and other social media accounts
- If your blog is work-related, it is better to let your employer know.
- Inquire if there are any employee social media guidelines. If there are, comply with them strictly.
- Use a disclaimer, e.g. "All opinions expressed here are those of their authors and not of their employer. Information provided here is for medical education only. It is not intended as and does not substitute for medical advice."

Summary

Social media is here to stay and is fast becoming the dominant way of information consumption and sharing for the general population and patients. Allergists have to be on social media to stay relevant and to provide meaningful service to patients.

The author can personally confirm the benefits of the approach outlined above. Dr. Dimov has used social media for professional purposes for more than 7 years while on staff at Cleveland Clinic and the University of Chicago. During that time his websites have had more than 8 million page views and attract daily 16,000 RSS subscribers, 9,000 Twitter followers and 2,600 visitors.

There are other physicians who are even more popular on social media and make the stats above look minuscule. You can be one of them. It benefits both your patients and your professional life.


RSS bundles of medical news

You can use the following RSS bundles to subscribe to medical news items. The bundles are exported from my personal Google Reader page. They update automatically several times per day. When in Google Reader, just select the ones that you find interesting and share them on Twitter. Feel free to add your own comments to some of the tweets.

Top Twitter Doctors

This is a list of the Top Twitter Doctors arranged by specialty in alphabetical order - feel free to add your own suggestions. The list is open to anybody to edit:

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