Monthly Archives: June 2014

When the Doctor Disappears

November 14, 2013, 5:00 am

When the Doctor Disappears

Sam Edwards/Getty Images

Dr. Daniel Geynisman felt as if he had abandoned his patient, a sickening sensation.

A 65-year-old man with metastasized gall bladder cancer had developed intractable pain before the doctor went away on vacation. By the time Dr. Geynisman returned, the patient was enrolled in hospice; he died soon thereafter. The oncologist never saw him again.

The sudden termination of a close doctor-patient relationship is a common, wrenching scenario. “I can tell you, it happens all the time and it breaks the heart of patients and families and oncologists,” said Dr. Diane Meier, director of the Center to Advance Palliative Care at Mount Sinai’s Icahn School of Medicine in New York City.

In an article published recently in the Journal of Clinical Oncology, Dr. Geynisman described his own experience with this sort of estrangement. He referred to his patient as “MM,” but the man’s actual name was Paul Rieger. He was a math teacher in the Chicago Public Schools who loved to golf and fish and who was married to his college sweetheart. Dr. Geynisman saw the couple every two or three weeks — and sometimes more often — during the last year of Mr. Rieger’s illness.

In a phone interview, the doctor described his patient as “very accepting, very calm, very kind, a gentle soul.”

From the beginning, the Riegers made clear what they wanted from their physician. “I distinctly remember during our first meeting they said they were looking for someone who would be with them through the end, throughout the whole journey,” Dr. Geynisman said.

Yet it was routine for oncologists at University of Chicago Medicine, where the doctor was then working, to stop seeing patients when treatment ended. “The model was, you get to know the patient and their family, you treat them aggressively, but when the time comes that you don’t have any more therapy to offer, you make a referral to palliative care or hospice and the patient goes under their auspices,” Dr. Geynisman said.

Dr. Otis Brawley, chief medical officer of the American Cancer Society and professor of oncology at Emory University, offered another reason oncologists sometimes disappear from their patients’ lives in these circumstances. “It’s a way of protecting yourself from the devastating feeling that you’re letting this person down and your inability to keep them alive is a professional failing,” he said.

That isn’t to say it’s justified. “No physician should ever say there’s nothing more I can do,” said Dr. Timothy Moynihan, medical director of the Mayo Clinic hospice, who wrote a response to Dr. Geynisman’s article noting that oncologists can remain involved with patients in hospice as the physician of record. “There’s always something more we can do for the patient — if only to be there and listen to their stories and deal with their pain and suffering.”

Dr. Geynisman said he had never received training about how to interact with a patient whom he could no longer help. But he felt terrible about not calling Mr. Rieger before his death and vowed this would never happen again.

“Do patients and their families want me, the primary oncology physician, to be around for the last phase of their lives?” he wrote in his article, which inspired dozens of emails from fellow oncologists across the country. “Do I ultimately break my pledge to patients as I prematurely end my journey with them when there is no longer ‘active therapy’ to offer them?”

The answer is yes, suggested Dr. Meier of Mount Sinai.

“Very often, one of the major sources of emotional and spiritual suffering among patients who are nearing the end of life or a prolonged illness is the abandonment they feel when they stop being cared for by a physician to whom they have become attached,” she said.

Dr. Meier told the story of a New York City oncologist who gave “impeccable” care to a woman with lung cancer, keeping her alive for almost seven years. Dr. Meier began caring for the patient as well when the oncologist turned away from addressing her questions about death. (“What exactly is likely to happen? Will I be in pain?”)

During a home visit three weeks before this woman passed away, Dr. Meier asked her what was on her mind. “She said, ‘I am really upset this doctor has not called me or come to see me.’ It was taking up most of her emotional energy.”

With the patient’s permission, Dr. Meier called the physician, whose response was, “There’s nothing I can do for her.” Dr. Meier had to explain: “She loves you. She wants to thank you.” That got through: the oncologist made a visit, and the patient died a few days later.

Mrs. Rieger has stayed in touch with Dr. Geynisman during the year since her husband’s death; she doesn’t blame the physician in any way. “He was our guiding light and he never disappointed us,” she told me. “Dan made the whole year so bearable, because I knew there was someone there for us.” The doctor, she noted, never let more than 10 minutes lapse before answering an email.

“He was the one person who knew our cancer journey better than anyone else,” Mrs. Rieger said. “He became so important to us. He touched our souls.”

Currently, Dr. Geynisman is an assistant professor of medical oncology at Fox Chase Cancer Center in Philadelphia. “I’m committed to being there through the end with all my patients, though I still haven’t figured out the best way to do that,” he said.

To his patients, he puts it something like this: “I’m still your physician and no matter what happens, I’m still here for you.”

Weight Gain and Older Women

February 19, 2014, 1:25 pm

Weight Gain and Older Women

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Michelle Obama has done an excellent job mobilizing the nation to combat childhood obesity and encouraging kids to eat better and move more. But now her efforts may be needed on another front.

Obesity can take a heavy toll on older women, too: Their risk of developing chronic diseases, losing the ability to walk or dying earlier increases with excess weight. We get the particulars from a large national study, recently published in JAMA Internal Medicine, that tracked more than 36,000 post-menopausal women at 40 research centers and universities around the country.

When the women enrolled in the Women’s Health Initiative between 1993 and 1998, they were between 66 and 79 years old (average age: 72). The researchers recorded the subjects’s heights, weights and health information, then followed up periodically thereafter. When the study concluded in 2012, the researchers found that the women fell into five categories:

  • *19 percent of these women were deemed healthy, meaning that “they survived to age 85 and had no major chronic diseases and maintained the ability to walk,” said lead author Dr. Eileen Rillamas-Sun, an epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle.
  • *Another 14.7 percent began the study with one or more of five chronic disease (cancer, heart disease, stroke, diabetes or hip fracture), but did not develop any additional health problems, and remained mobile.
  • *Nearly a quarter, 23.2 percent, developed one or more of the diseases during the study period, but maintained their ability to walk.
  • *18.3 percent did lose their mobility — meaning they required crutches, walkers or wheelchairs — or reported limited ability to walk a block or climb a flight of stairs. The researchers used this measure of disability, Dr. Rillamas-Sun said, because “losing one’s ability to walk contributes to loss of independence.”
  • *The remaining women, 24.8 percent, died before age 85.

When the researchers looked at the impact that obesity or being overweight — calculated by body mass index — took on the women’s health, “we found that women with a healthy body weight had a greater chance of living to 85 without developing a chronic disease or a mobility disability,” Dr. Rillamas-Sun said. “The heavier you are, the worse your chances of healthy survival.”

Now some New Old Age readers — you know who you are — are already mentally composing comments like, “Didn’t we already know that obesity is bad for us?” and “We needed a study funded by the National Institutes of Health to tell us this?”

We did, on both counts. But older people and women have historically been underrepresented in — or actually excluded from — research trials. For years, experts assumed that findings from all-male studies applied to women, too, which has proved to be untrue.

Also, aside from gender disparities, “a lot of research focuses on everyone 65 and older,” Dr. Rillamas-Sun pointed out. “We looked at the old-old” — those who are 85-plus.

But it is true that this work confirms what we thought we knew: Overweight women run a higher risk of health problems and disability, and those risks rise sharply when overweight becomes obese.

Compared to older women with healthy body mass indexes (below 25), overweight women had a 20 percent greater chance of developing one of the five diseases. But women with Level 1 obesity (B.M.I. over 30 but below 35) had a 65 percent higher risk of disease, and women with higher levels of obesity were more than twice as likely to develop disease. The likelihood of dying before age 85 showed a similar pattern. (The data has been adjusted to account for demographic differences and health behaviors like smoking.)

When it came to losing mobility, the researchers found even more striking differences. Overweight women had a 60 percent higher risk of losing the ability to walk, but obese women were three to six times more likely to lose their mobility. For African-American and Hispanic women who were overweight or obese, the odds of disease, disability or death before age 85 were higher yet.

What this study doesn’t address is whether losing weight later in life can protect older women from disease and disability. But the researchers are working on that. (And of course, some factor other than obesity might be involved because — all together now — correlation is not causation.)

But we shouldn’t wait for Dr. Rillamas-Sun’s next publication to try to reduce obesity in older women.

Paging the First Lady. Women often do gain weight after menopause, and losing it can be harder than when we’re 35 (a challenge with which I’m all too familiar). But it’s not impossible, and the effort is worth undertaking — for our aging parents, and for ourselves.

“This says, you can’t be in denial any longer,” said Dr. Rillamas-Sun. “Most people need to see the numbers; they prove what is supposedly obvious. And we do have the numbers.”

Paula Span is the author of “When the Time Comes: Families With Aging Parents Share Their Struggles and Solutions.”

Would working less make you happier?

Health & Medicine

Would working less make you happier?

Christine Carter, director of Greater Good Parents | 10/3/13 | 3 comments | Leave a comment
Christine CarterAre you caught in a “Time Bind”— where you feel like you don’t have enough time to get your work done AND spend time with your children and spouse AND take care of your own basic needs?Sociologists have been very excited about a “natural experiment” occurring in Korea. In 2004, the Korean government began mandating that businesses cut their workweek back, from six to five days. Researchers now have almost a decade of data about how these widespread changes have affected people’s satisfaction with their jobs and, importantly, with their lives.What is exciting about this situation is that it should improve our understanding of how number of hours worked per week affects job and life satisfaction. We already have research that shows pretty clearly that working long hours is correlated with work-family conflict and other forms of misery — but we don’t know whether working long hours causes unhappiness or whether, say, unhappy people disproportionately work for companies which require longer hours.If I regularly worked one less day per week, I think I would definitely be happier with my job, my work hours, and with my life overall. Truly, I can’t think of any maxed-out mom, or even just any working parent, who doesn’t dream of someone mandating that they work less.

That’s why I was surprised by the results: The most recently published study on this topic seems to show that the Korean Five-Day Working Reform did not have “the expected positive effects on worker well-being.” Ten years and one less workday per week, people aren’t happier with their jobs or their lives overall.

Say what? Despite a dramatic correlation between working less overtime and feeling happier, researchers didn’t find that the government-mandated reduction in work hours made people happier on average when they controlled for things like income.

Their theory about why: Employers didn’t reduce employee workload when they reduced their work hours. Workers actually only reduced their work time by four “official” hours per week, not eight. This means workers had four fewer hours in which to do their work; either they crammed it in by working more efficiently in fewer, longer days, or they kept working the same amount of time but did their work off the books.

Maxed-out workers need less work, not less time to do the same amount of work. Part of what I find so harrowing about parenting is the time pressure. It’s stressful to have the same amount of work but less time in which to do it.

All this is to say that the obvious solution to our Time Bind — a government mandate that we work less — is probably not coming soon to a workplace near you.

But I’m not saying that our government doesn’t need to help maxed-out parents.

The problems plaguing working parents aren’t our own individual problems. It isn’t that we feel “overwhelmed and overworked simply because [we’ve] individually taken on too much or done a bad job coping with [our] responsibilities,” as Sharon Lerner writes in The War on Moms.

Our collective exhaustion is sociological. Its roots come from the way our society and economy is structured. As Katrina Alcorn puts it in Maxed Out, “We lack the social and systemic supports that we need in order to realize our potential and share our talents with the world.”

At the same time, we set ourselves up for a lot of disappointment, not to mention feelings of victimization, when we hold fast to the belief that we need to change our institutions — our government, our workplaces, our marriages — before we can be happy in life and productive and successful at work. There are three important things we can do to prevent our own breakdowns.

In my next post I will lay out three strategies for preventing burnout among working parents that will help you step away from the brink of breakdown.

Cross-posted from Christine Carter’s blog, Raising Happiness, (tag line: Science for Joyful Kids and Happier Parents).

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Comments to “Would working less make you happier?”:
    • Semangat

      Working less make happier? I think this was interesting topic to share and every country have this problem. Each country have their own regulation to decide how much the working days in week. In my country many company are working five days in week like Bank office. Working five days can make the employee have many time to relax, holiday or their family. So the employee will feel fresh on Monday start working.

      [Report abuse]

    • John

      I agree with you in this comment. “We already have research that shows pretty clearly that working long hours is correlated with work-family conflict and other forms of misery, but we don’t know whether working long hours causes unhappiness or whether, say, unhappy people disproportionately work for companies which require longer hours.” I love tihs blog and I continue reading all the time.

      [Report abuse]

    • Anthony St. John ’63

      My life experiences have taught me that we must focus more on practicing the Golden Rule in all of our work, social and family activities.

      Since I retired, I have been involved in continuous study and thinking about how to overcome the negative challenges of change that increasingly affect our lives, our civilization, the long-term future of the human race and how to provide a legacy of happiness, equality and opportunities for all in our newest and all future generations.

      I hope and pray that we give highest priority to creating and implementing solutions to our challenges in time to achieve happiness for the entire human race into the long-term future

Health Check: are saturated fats good or bad?

27 January 2014, 8.29am AEST

Health Check: are saturated fats good or bad?

Dietary guidelines cite the fact that saturated fats can increase LDL cholesterol, which is also known as bad cholesterol because it’s a major risk factor for heart disease. Others claim saturated fats…

A diet high in particular saturated fatty acids can increase your body’s cholesterol production. Penn State/Flickr

Dietary guidelines cite the fact that saturated fats can increase LDL cholesterol, which is also known as bad cholesterol because it’s a major risk factor for heart disease. Others claim saturated fats are not a problem.

So is saturated fat a saint or sinner? Or could the search for a single culprit miss the inevitable subtleties of a multifactorial problem such as heart disease?

These are complex questions so let’s start with what cholesterol and fats actually are and the different types.

Cholesterol is a waxy substance found only in animal products. It’s an essential component of our bodies, easily made within the body. A diet high in particular saturated fatty acids can increase cholesterol production, assisted by genetic factors, to levels that dramatically increase the risk of heart attacks.

Fats in food

The fats in food are categorised on the basis of their chemical structure as saturated, monounsaturated or polyunsaturated. Polyunsaturated fatty acids are further divided into omega 3s and omega 6s (here’s a more detailed description).

Individual foods are defined by the major type of fatty acid they contain. So olive oil is tagged “monounsaturated” although 16% of its fatty acids are saturated and 9% are polyunsaturated.

A “polyunsaturated” margarine spread may have 45% polyunsaturated fatty acids, 30% monounsaturated and 25% saturated. That’s less than the 70% saturated fat content of butter, but it’s not an insignificant amount by any means!

Fats in blood

Being insoluble in liquid, fats and cholesterol are carried in the blood in protein-fat compounds (called lipoproteins) that vary in their density and function.

Low-density lipoproteins (LDL) carry cholesterol from the liver and can deposit it in plaque on the walls of the coronary (and other) arteries. This can restrict blood flow and, aided by inflammatory reactions, plaque can block an artery causing heart attack or stroke.

Butter has much more saturated fat than margarine but is considerably less processed. Susy Morris

That’s why LDL cholesterol is often tagged as “bad” (high LDL levels may also be responsible for erectile problems in men). LDL cholesterol can also bind to another heart disease risk protein called apolipoprotein(a) or Lp(a).

High-density lipoproteins (HDL) carry stray bits of cholesterol back to the liver for disposal and are therefore “good”. The ratio of total to HDL cholesterol to LDL cholesterol now appears to give a stronger correlation with heart disease than LDL levels on their own.

Triglycerides are the form of fat circulating in the blood immediately after meals that are available to cells for energy and likely to be used during physical activity. Any excess, which can come from too much ingested fat, carbohydrate or alcohol, is stored as body fat.

High triglyceride levels frequently accompany high LDL, low HDL and upper body fat. The omega 3 fats found in fish may help lower triglycerides.

Types of saturated fat

Of the many saturated fatty acids in foods, three (myristic acid, palmitic acid and lauric acid) have the greatest effect in raising blood cholesterol.

Large quantities of shorter chain fatty acids (especially caprylic and capric found in foods such as butter, goat and cow’s milk cheeses, and coconut) can increase triglyceride levels.

Some saturated fatty acids such as stearic acid (in meat fat and chocolate) can increase triglyceride levels, but have no effect on blood cholesterol.

Lauric acid, one of the major fatty acids in coconut oil, may raise both LDL and HDL. This makes it less “bad” than its total saturated fat implies. Still, while coconut oil may be better for LDL blood cholesterol than butter, it’s not as good as liquid oils, such as safflower oil.

All this may sound a little complicated (and it is) but there’s something simpler at the heart of the issue that’s much more important.

Foods vs nutrients

Claims that saturated or unsaturated fats are “good” or “bad” are distorted by ignoring their food sources.

Judging foods only by their saturated or monounsaturated fat content ignores their complete nutritional profile. Tom Magliery

Consider that the same quantity of saturated fat is found in 35 grams of cheese, 35 grams of white chocolate, 70 grams of potato crisps, 90 grams of roasted cashews, a small (145 grams) rump steak, a tablespoon of lard, 50 grams of polyunsaturated margarine, a small custard tart and 15 grams of hollandaise sauce!

The same goes for other fats. Monounsaturated fats, for instance, are the dominant type of fat in chicken noodle soup, eggs, peanut oil, avocado, liquorice, almonds, rolled oats, chocolate chip muesli bars and chicken nuggets.

It would clearly be a nonsense to assume these foods were nutritionally equivalent, but judging only their content of saturated or monounsaturated fat creates that absurdity.

Early studies using liquid oils added to a standard diet reported that unsaturated fatty acids lowered blood cholesterol.

In Mediterranean populations, most unsaturated fats come from olive oil and nuts – foods with wide range of other beneficial components. But in North America and Australia, major sources of unsaturated fats include products such as frying oils and spreads.

Until fairly recently, spreads were made by partially hydrogenating (adding hydrogen atoms to) liquid oils. The same process was used for oils for commercial frying, snack foods, confectionery, pastries, biscuits and crackers and anything with a crisp coating.

It took scientists years to realise that partial hydrogenation produces an unsaturated, but nasty trans fatty acid called elaidic acid. This fat raises LDL cholesterol, lowers HDL cholesterol, increases inflammation and has a string of other undesirable effects.

Mediterranean dietary patterns favour a variety of fruits, vegetables, legumes, nuts and grains, with extra virgin olive oil, herbs and spices. Roberto/Flickr

Other processes are now used to make spreads, but we have no way of identifying other foods with elaidic acid as it need not be labelled in Australia. It was recently found in margarine sold in remote communities.

Saint or sinner?

Going back to the question we started with, whether saturated fat is a saint or sinner depends on the quantity consumed and on other features of the food containing it.

One oft-quoted review of observational studies concluded there was no association between saturated fat and heart disease.

But one of the authors of the paper is supported by Unilever and two are “supported by the National Dairy Council”, so there are clear conflicts of interest involved. One also receives support from the National Cattlemen’s Beef Association.

What’s more, major flaws in the study’s methodology have been pointed out.

Food companies complicated matters by producing many low-fat foods with sugar and refined starches replacing fat. This has been counterproductive although randomised controlled trials have established strong evidence of benefit by substituting unsaturated fats, especially those from seafood.

The fact is, the diversity of foods containing saturated and unsaturated fats in modern diets is a major source of confusion. A simple way through the muddle is to follow dietary patterns associated with low levels of heart disease and other health problems. This also helps avoid the absurdity created by thinking in terms of individual nutrients rather then whole foods.

My bias is for Mediterranean dietary patterns that favour few highly processed junk foods, cheese and yoghurt rather than butter and only modest meat intake.

The basis of the day’s meals includes a variety of fruits, vegetables, legumes, nuts and grains, with extra virgin olive oil, herbs and spices. Foods high in butter or sugar are enjoyed on special occasions. It’s an enjoyable and proven healthy way to eat.

Some reasons why you should avoid sleeping pills

28 January 2014, 6.40am AEST

Some reasons why you should avoid sleeping pills

We’ve known for a long time that hypnotic drugs are not good to take for more than one to three weeks because they are habit-forming and increase the risk of accidents. And there’s now a growing body of…

There are effective non-drug options for treating insomnia. Alyssa L. Miller

We’ve known for a long time that hypnotic drugs are not good to take for more than one to three weeks because they are habit-forming and increase the risk of accidents. And there’s now a growing body of evidence that shows they could be increasing the risk of premature death.

Hypnotics are medicines prescribed specifically to help people suffering from insomnia get a good night’s sleep. This includes people who have difficulty getting to sleep as well as those who struggle to stay asleep.

The class of hypnotics prescribed the most are benzodiazepines or very closely related drugs. In this benzodiazapine class are temazepam (Normison, Temaze), flunitrazepam (Hypnodorm) and nitrazepam (Mogadon).

While these drugs are typically prescribed to people suffering from insomnia, some other well known benzodiazepines such as diazepam (Valium), oxazepam (Serepax) and alprazolam (Xanax) are also prescribed for anxiety.

The “Z” group of newer hypnotic medicines such as zolpidem (Stilnox) and zopiclone (Imovane, Imrest), are very similar to the benzodiazepines in their mechanisms of action and have identical issues.

Problems and more problems

Despite claims to the contrary, no hypnotic delivers sleep of the same quality as natural sleep. And there are a number of proven non-drug treatment options for insomnia, such as simple relaxation techniques that are definitely better in the long term.

The hypnotic drugs, on the other hand, are habit forming, dull cognitive abilities, increase the risk of hip fractures from falls and make other accidents more likely, especially when combined with alcohol.

They also cause serious withdrawal reactions when chronic use is stopped suddenly. Such reactions include seizures (with the risk of fractures), but more commonly, worse insomnia (and often anxiety) continue for weeks after stopping taking the drugs.

But despite these problems, a large and fairly static proportion of the population (about 6% to 10% of adults) continue to take these drugs over long periods of time. And this rate increases among older people, particularly women.

It gets worse

Adding to the already serious concerns about these drugs, there are now alarming reports linking all hypnotics with premature death and cancer.

There are a number of problems associated with long-term use of hypnotic medicines. Life Mental Health (Image cropped)

Most recently, a study of over 10,000 people with the average age of 54 years who were prescribed hypnotics found they had a threefold or more increase in the risk of death compared to those not taking the drugs.

The researchers estimated between 300,000 to 500,000 excess deaths each year in the United States alone associated with hypnotic use. It didn’t matter which hypnotic drug was examined, and this included the newer shorter acting “Z” drugs such as zolpidem (Stilnox).

This well-performed study adds to over 20 others linking these drugs to premature death and a cancer diagnosis.

A lingering criticism

The obvious criticism of this line of research is that people taking hypnotics already had cancer or poor health and that was part of the reason they had sleeping problems and were prescribed the drugs in the first place.

Indeed, it’s fair to accept the possibility of the results being confounded or distorted by some undetected medical condition in a high proportion of the group prescribed hypnotics. This is always a concern and a possibility of observational studies.

The ideal would be to do a controlled study over two and a half years and randomly allocate individuals with disrupted sleep to either hypnotic medicines or a matched placebo and see if the results hold up.

But while this ideal study would most likely eliminate substantial biases, it would not be ethical. Best practice for insomnia treatment is not to prescribe these drugs beyond a few weeks and to rely on proven methods not involving drugs at all.

So we’re unlikely to have much better proof that there’s a greater risk of death and cancer among people who take hypnotics.

Seek alternatives

The possible mechanisms for this apparently substantial effect (premature death) remain elusive, but there are a number of possible reasons.

We know that a combination of hypnotic drugs and alcohol increases the risk of depression of brain functions that can lead to slowing of breathing. This can be lethal, especially for people who have chronic heart or lung disease.

And people taking hypnotics are more likely to have car and other accidents due to the hangover effects the next day. The drugs also increase rates of depression and therefore the risk of suicide.

But despite remaining uncertainties, this is another strong signal for prescribers and the community to be wary of chronic use of hypnotic drugs.

There’s certainly no good rationale for long-term hypnotic use. And there are effective non-drug options for treating insomnia that are not pursued nearly often enough

Don’t panic! Healthy consumers look online for medical advice

      12 February 2014, 2.38pm AEST

        Don’t panic! Healthy consumers look online for medical advice

We’ve all heard the warnings against googling your symptoms in search of a diagnosis: you’ll uncover a range of daunting illnesses and launch into panic-mode over something like a measly cold. There is…

        Health consumers don’t necessarily use the internet to bypass their GP, they use it as an additional source of information.           Flickr/Chelsea Louise      

We’ve all heard the warnings against googling your symptoms in search of a diagnosis: you’ll uncover a range of daunting illnesses and launch into panic-mode over something like a measly cold. There is even a term to describe the compulsive searching for information about symptoms of illness online: cyberchondria.

Our research shows the plethora of health information online isn’t something we should necessarily be worried about: for the most part, it complements the role of medical practitioners and helps patients make more informed decisions.

But when it’s combined with poor health literacy, problems may occur.

Why do we google symptoms?

Our study found that online self-diagnosis of symptoms is now a normal, everyday activity. People have always sought information and diagnoses from other sources, often before they decide to see their doctor. The internet is an extension of this practice.

Concerns have been raised that online self-diagnosis websites encourage people to self-medicate. Again this is not new; self-medication with over-the-counter and alternative medications has always been part of people’s health strategies.

Our research found that people are not googling their symptoms as a replacement to their GP. Rather, they use the internet as an additional source of information to learn about their health condition and make decisions about treatment options.

Ultimately, consumers tend to feel more confident about their health care decisions when they are actively involved in the decision-making process. One interviewee said:

I look on the internet always. I don’t always trust what you read in there. You can’t always do your own diagnosis. Then I’d definitely go to my GP, and we’d have a discussion about it [and] whatever advice she gives me, I’d probably take it.

Seeking health advice from other sources is nothing new. bcymet/Flickr

The internet was just one of many sources of information that participants drew on when seeking to learn about their symptoms. They also talked to family, friends and colleagues, read newspapers, listened to the radio and used Facebook or chat rooms. As one interviewee said:

I’d go online or phone a friend [then] I’d talk to the doctor. The doctor might say something, and I might think, oh I don’t know whether that’s right. I wonder what [my friend] thinks. I might get some sort of diagnosis from the doctor and then say “oh, well that’s interesting, but I’d like to do a bit more research on that”, or ask somebody that’s had that problem.

Our research found that participants were aware that not all online sources are reliable and were cautious about where they searched for information.

Improving health literacy

As we gain increasing access to the growing volume of health information online, there is a growing imperative for consumers to gain the skills and knowledge to understand online information.

However, an estimated 60% of Australian adults have poor health literacy and may struggle to make sense of the information they find on the internet.

People with low healthy literacy have more dependence on health services and providers because they are less able to self-manage chronic health conditions and have less knowledge about the links between health and lifestyle behaviours such as nutrition, exercise, alcohol and smoking.

Health care is a big business and some online information is focused on generating profit rather than providing evidence-based advice. Sometimes, the distinction between business and information is not clear.

Health providers can no longer rely on authority alone to convey information. Flickr/PBrewer

Health care providers can help. They can direct people to websites from recognised health organisations such as Healthinsite, Better Health Channel, MayoClinic and NHS Direct.

Some health care providers and advocacy groups are now using social media sites such as Facebook, Twitter, Youtube and mobile apps to provide quality health information to consumers. In an environment where there are multiple sources of information – and not just the authority of medicine – health care providers are increasingly realising they can’t ignore social media.

Online information, including social media, needs to be part of health care workers’ approach to providing high-quality health care.

For those with high health literacy, credible online information is a valuable addition to their health care regime. Health care workers can assist those with lower health literacy to use online information.

What Makes Older People Happy

February 11, 2014, 4:01 pm

What Makes Older People Happy


Every year, my husband and I wonder what kind of birthday gift to give his dad, now 86 years old.  The newest gadget, which may be admired but almost surely will be put in a drawer? Something much more ordinary, like one of the cardigan sweaters he wears day in and day out?

We know very well what Mel would really enjoy:  a weeklong visit with us and our children, with lots of time spent eating out in comfortable restaurants where he doesn’t have to strain to follow the conversation.  But that is hard to engineer, since we all live far away.

A recent study helps me better why understand Mel so appreciates the same tried-and-true interactions that provoke a “not again” groan from my husband.  The report, scheduled for publication this year in The Journal of Consumer Research, finds that the kinds of experiences that make people happy tend to change over time.

When we’re young and believe we have a long future ahead, the authors found, we prefer extraordinary experiences outside the realm of our day-to-day routines.  But when we’re older and believe that our time is limited, we put more value on ordinary experiences, the stuff of which our daily lives are made.

Why?  For young people trying to figure out who they want to become, extraordinary experiences help establish personal identities and are therefore prized, said Amit Bhattacharjee, the lead author of the study and a visiting assistant professor of marketing at Dartmouth College.  As people become more settled, ordinary experiences become central to a sense of self and therefore more valued.

“It’s just what you would expect, this emphasis on savoring what you already have when your time starts to become limited,” said Peter Caprariello, an assistant professor of marketing at Stony Brook University who wasn’t involved in the research.

The study findings are drawn from eight experiments all revolving around the same theme. In one of them, Dr. Bhattacharjee and co-author Cassie Mogilner, an assistant marketing professor at the University of Pennsylvania, asked people aged 18 to 79 to recall an experience that was extraordinary or ordinary, and then asked them to rate their emotional responses.  The conclusion: happiness derived from extraordinary experiences remained fairly constant, but pleasure from ordinary experiences increased as people got older.

Another experiment demonstrated that an individual’s perception of the future — whether it was open-ended or limited — was a critical factor in explaining the results.  This is consistent with studies by Laura Carstensen, a professor of public policy and psychology at Stanford University, which posit that older adults’ sense that time is limited alters their emotional perspective, causing them to invest energy in what is most meaningful to them.

“I really like this paper because it ties together several important lines of research,” said Jim Bettman, a professor of business at Duke University.  Previous research has shown that experiences make people happier than material possessions and that sharing experiences with others generates the most pleasure.

Adding a developmental perspective, Dr. Mogilner demonstrated in 2011 that the perception of happiness changes over time, with younger people feeling more rewarded by feeling excited and older adults getting a bigger boost of satisfaction from peace and calm.

One notable limitation in this new study is the relatively small sample of people in their 70s who participated in the experiments.  “It would be nice to know how long the effect they’ve observed persists, but this can’t be established,” Dr. Caprariello said.

The implications?  The things we enjoy aren’t necessarily what will make our older parents or relatives happy. The point isn’t to rip them from their routines and get them to try something new because you think that’s good for them. Like my father-in-law, they may much prefer to do the things they do ordinarily with us at their side.

Why Vitamins May Be Bad for Your Workout

Phys Ed February 12, 2014, 12:01 am

Why Vitamins May Be Bad for Your Workout

Phys Ed
Phys Ed

Gretchen Reynolds on the science of fitness.

Many people take vitamins as part of their daily fitness regimens, having heard that antioxidants aid physical recovery and amplify the impact of workouts. But in another example of science undercutting deeply held assumptions, several new experiments find that antioxidant supplements may actually reduce the benefits of training.

Antioxidants became popular dietary supplements largely because they were said to sop up free radicals, the highly reactive oxygen molecules that are generated during daily activities. Physical exertion, through its breakdown of oxygen, results in the creation of large numbers of these molecules, which, in excess, can lead to cell death and tissue damage. So it seems logical that reducing the number of free radicals produced by exercise would be desirable.

Enter antioxidants, which absorb and deactivate free radicals. While the body creates its own antioxidants, until recently many researchers believed that we produce too few natural antioxidants to counteract the depredations from free radicals created during exercise. So many people who exercise began downing large doses of antioxidants such as vitamins C and E, even though few experiments in people had actually examined the precise physiological impacts of antioxidant supplements in people who work out.

For a study published last week in The Journal of Physiology, researchers with the Norwegian School of Sport Sciences in Oslo and other institutions gathered 54 healthy adult men and women, most of them recreational runners or cyclists, and conducted a series of tests, including muscle biopsies, blood draws and treadmill runs, to establish their baseline endurance capacity and the cellular health of their muscles.

Then they divided the volunteers into two groups. Those in one group took four pills a day, delivering a total dose of 1,000 milligrams of vitamin C and 235 milligrams of vitamin E. Members of the second group got identical placebo pills.

Finally, they asked all of the participants to complete a vigorous 11-week training program, consisting of increasingly intense interval sessions once or twice per week, together with two weekly sessions of moderately paced hour-long runs. By the end, all of the volunteers were more fit than they had been at the start, with their maximum endurance capacity increasing by an average of about 8 percent.

But their bodies had responded quite differently to the training. The runners who had swallowed the placebo pills showed robust increases of biochemical markers that are known to goose the creation of mitochondria, the tiny structures within cells that generate energy, in cells in their bloodstream and muscles. More mitochondria, especially in muscle cells, means more energy and, by and large, better health and fitness. The creation of new mitochondria is, in fact, generally held to be one of the most important effects of exercise.

But the volunteers who had consumed the antioxidants had significantly lower levels of the markers related to mitochondrial creation. The researchers didn’t actually count the specific populations of mitochondria within their volunteers’ muscles cells, but presumably, over time, those taking the antioxidants would see a smaller uptick in mitochondrial density than among those not taking them.

That finding echoes the results of another study of antioxidant supplementation and exercise, also published last year in The Journal of Physiology, in which half of a group of older men downed 250 milligrams daily of the supplement resveratrol, an antioxidant famously found in red wine, and the other half took a placebo. After two months of exercising, the men taking the placebo showed significant and favorable changes in their blood pressure, cholesterol profiles and arteries, with fewer evident arterial plaques.

The men taking the resveratrol were not as fortunate. They had exercised as much as the other men, but their blood pressures, cholesterol levels and arteries had remained stubbornly almost unchanged.

Why and how antioxidant supplements would blunt the effects of exercise is not altogether clear, said Goran Paulsen, a researcher at the Norwegian School of Sport Sciences, who led the vitamin C and E study. But he and many other physiologists have begun to suspect that free radicals may play a different role during and after exercise than previously thought.

In this theory, free radicals are not villainous but serve as messengers, nudging genes and other bodily systems into starting the various biochemical reactions that end in stronger muscles and better metabolic health. Without free radicals, those reactions don’t begin.

And large doses of antioxidant supplements absorb most of the free radicals produced by exercise.

Of course, that theory is still unsubstantiated and requires long-term testing in people, Dr. Paulsen said. It is possible, he said, that smaller doses of antioxidants or different formulations might be useful for athletes. Meanwhile, natural antioxidants from food sources, such as blueberries and red wine, are unlikely to be problematic, he said. “It’s probably only concentrated extracts that are potentially dangerous,” he said. It is also worth pointing out that the volunteers who took the concentrated extracts of vitamins C and E increased their endurance to the same extent as those taking a placebo.

On the other hand, the supplements did not improve performance in comparison with a placebo, so why bother with them, Dr. Paulsen asked. “Personally, I would avoid high dosages” of antioxidants while training, he said. The science on the topic may not be complete, but the intimation of the recent studies is that by downing the supplements, “you risk losing some of the benefits of exercise.”

Erectile dysfunction may be more than just a problem in bed

10 February 2014, 6.06am AEST

Erectile dysfunction may be more than just a problem in bed

Erection problems are common but they can be embarrassing for men to discuss with partners and doctors. The sales of erection drugs on the internet or billboard advertising are boosted by keeping erectile…

Discussions of erectile function can be challenging but it’s important for more than your sex life. Tom Small/Flickr

Erection problems are common but they can be embarrassing for men to discuss with partners and doctors.

The sales of erection drugs on the internet or billboard advertising are boosted by keeping erectile problems in the dark. They reinforce the idea that it’s an embarrassing problem that can be fixed without seeking help from doctors.

But this means men are missing out on an opportunity to improve their health.

Many men will be surprised to learn that erectile dysfunction affects about one in five men over the age of 40 and two in three men over 70. There’s also increasing research evidence linking erectile dysfunction with other general health problems, such as diabetes and heart disease.

And it’s becoming clearer that erectile dysfunction can be an early warning sign of chronic health conditions, but many men and some doctors still don’t appreciate this.

Erectile dysfunction and diabetes

The greater risk of erectile problems in men with diabetes has been known for some time with studies estimating that up to four in five men with diabetes will have erectile dysfunction at some time in their lives. This is twice the rate in men without diabetes.

Diabetes can cause reduced blood flow to the penis or affect the function of penile blood vessels, making it more difficult to get an erection. It can also damage the nerves in the penis (and elsewhere in the body).

Diabetes is often associated with high blood pressure, high cholesterol and obesity – each of these is an independent risk factor for erectile dysfunction. Less commonly, the lower levels of testosterone in men with diabetes may contribute to erectile dysfunction.

Just as in men without diabetes, psychological issues including “performance anxiety” can also cause erectile dysfunction or make the situation worse once a man starts to experience erectile problems.

In some cases, men presenting with erectile dysfunction may have undiagnosed diabetes (or hypertension or high cholesterol). A blood glucose test from a doctor, and if levels are high, diabetes treatment, can help both the erectile problems and other health problems caused by diabetes.

Erectile dysfunction and cardiovascular disease

Erectile dysfunction is increasingly being recognised as an early warning sign of future cardiovascular disease, particularly coronary heart disease.

Erectile dysfunction can be an early warning sign of chronic health conditions. Len Matthews/Flickr

An Australian study has shown about twice the risk of a later cardiovascular event (such as heart attack or stroke) in men aged 20 years or older with erectile dysfunction, compared to similarly aged men in the general population.

Men with diabetes and erectile dysfunction also have a higher risk of a subsequent cardiovascular event, than other men with diabetes.

The risk of a cardiovascular event after developing erectile dysfunction is similar to that of being a smoker or having a family history of coronary heart disease.

One study has shown that within a year of the first significant episode of erectile dysfunction in men aged 55 years or over, one in 50 had a major stroke or heart attack. And within five years, it was greater than one in ten men.

It seems that erectile dysfunction in younger men is an even stronger predictor of later cardiovascular disease than in older men.

The link between erectile dysfunction and cardiovascular disease is thought to be due to a common underlying vascular problem. As blood vessels in the penis are smaller, they may be affected earlier than other parts of the body, such as the heart.

In this instance, the penis acts as a window to the health of the circulatory system.

Getting checked out

The best way to get help for erectile problems is to see a doctor to discuss the problem.

Undergoing a general health check including measurement of cardiovascular disease risk factors including diabetes, hypertension, high lipid levels, smoking, obesity and low level of physical activity will help.

As will a discussion of psychosocial issues that might be contributing to the problem and the importance of restoring sexual function. In some cases, a testosterone measurement may be done.

Discussions of sexual issues and erectile function can be challenging for both doctors and men. But understanding more about erectile dysfunction, and its links with other health problems can be a motivating factor for men to take steps to improve their erectile function and general health.

What is music therapy?

9 December 2013, 3.08pm AEST

Explainer: what is music therapy?

Defining music therapy is challenging because the practice is so diverse; but the Australian Music Therapy Association (AMTA) uses the following definition: Music therapy is a research-based practice and profession in which music is used to actively support people as they strive to improve their health…

Music therapists work with people of any age and ability, culture or background. flyzipper

Defining music therapy is challenging because the practice is so diverse; but the Australian Music Therapy Association (AMTA) uses the following definition:

Music therapy is a research-based practice and profession in which music is used to actively support people as they strive to improve their health, functioning and wellbeing.

Music therapy is the intentional use of music by a university-trained professional who is registered with the AMTA.

Registered music therapists draw on an extensive body of research and are bound by a code of ethics that informs their practice. They incorporate a range of music-making methods within a therapeutic relationship and are employed in a variety of sectors including health, community, aged care, disability, early childhood, and private practice.

Music therapy is different from music education and entertainment as it focuses on health, functioning and wellbeing, and music therapists work with people of any age and ability, culture or background.


The use of music in healing has had a long history, but music therapy as a profession began to develop formally in USA in the 1950s to help war veterans suffering from physical and emotional problems. The demand for a university curriculum grew as hospital musicians needed training.
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The American Association for Music Therapy was established in 1971 and the Australian Association soon after in 1975 by music therapy pioneers Dr Ruth Bright and Emeritus Professor Denise Grocke.

As anyone who sings or plays a musical instrument will tell you, making music, especially with others, is great for the mind, body and soul. The benefits flow whether you are an accomplished musician or an enthusiastic amateur.

Music therapists draw on the benefits of music to help people of all ages and abilities attain and maintain good health and wellbeing. They work in a range of places including hospitals, nursing homes, schools and the community, delivering tailor-made programs to meet specific needs.

Endorphin, dopamine and oxytocin triggers

The techniques used by music therapists can include writing songs for or with clients, free or structured movement to music activities, singing and vocal activities, improvisation, playing traditional instruments or digital music equipment, listening to recorded music and engaging socially in a group setting.

The ability of music to change our mood seems to be related to the production of different chemicals in the brain. Endorphins triggered by music listening and music-making provide a kind of natural pain relief, where dopamine leads to feelings of buoyancy, optimism, energy and power.

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This may explain the kinds of “flow” and “peak” experiences often described as being evoked by both music-listening and more active musical participation.

Impacts are even more potent for group music-making, because shared, positive experiences also release oxytocin, a brain tool for building trust. In this way, musical relationships develop encouraging non-verbal and emotional expression and building self-esteem, motivation and confidence.

Music therapy in neurorehabilitation

Music is processed widely across the brain in connection to memories, emotions and communication. Developments in brain-scanning technology show that making music increases brain activity, creating new pathways across both hemispheres of the brain.

This makes music therapy especially beneficial in neurorehabilitation where the organising function of rhythm in music can be used to rehabilitate movement and speech following a brain injury or stroke.

The small, black arrow points to the region of our brain devoted to music appreciation and music-making. Mikey G Ottawa
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Music therapy and dementia

There is a strong connection between music and memory as can be attested by the flood of emotion stimulated by hearing significant songs, or the annoying advertising jingles that get stuck in your brain.

Music therapists use this feature of music to help people with memory difficulties access important pieces of information in specifically composed songs.

Memory for music is closely linked to emotions and both are processed deeply within the brain. Memory for song lyrics often remains long after other memory and verbal ability have deteriorated for people with dementia.

Music therapy often awakens something within people in late-stage dementia and can stimulate windows of lucidity, providing family members with glimpses of the person they love.

Music therapy in children’s hospitals

Music therapy is frequently used in children’s hospitals for pain and anxiety management during procedures and to engage children in a normalising activity that is unrelated to them being unwell. This provides an opportunity for choice and control in an environment where they have little control over everything else.

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In special education, music therapists work with children with intellectual and/or physical disabilities to help them meet developmental and educational goals. This may include using music to increase opportunities for cognitive and sensory stimulation and to help develop motor skills, orientation and mobility.

Music therapy provides an outlet for a child’s emotional expression, increased awareness of the immediate environment and other people, and enhances self-confidence through active music making. It can also help improve a child’s social skills and communication.

Teenagers and music

Young people spend a significant amount of time engaging with music and vulnerable teenagers spend even more so. Music therapists in adolescent mental health use this strong connection that teens have with music as a resource in grappling with their emerging mental health problems.

The Australian Research Council has recently funded a research project headed by Assoc. Prof Katrina McFerran to investigate the music uses of young people with and without mental ill-health with a view to early identification and early intervention in adolescence.