Work that brain

A new study published in the Archives of Neurology on January 23 reported a strong association between cognitive activity and beta-amyloid deposits in the brain. Beta-amyloid is the protein that destroys brain tissue in people with Alzheimer’s disease. Study researchers from the University of California in Berkley found that cognitive activity throughout a person’s early and middle life had a direct impact on the degree of beta-amyloid deposits. The more cognitive activity, the fewer deposits. The kinds of cognitive activity reported in this paper are well within the reach of everyone, such as reading, writing (including writing letters and emails), going to the library, and playing games. Although genetics certainly plays a role in the development of Alzheimer’s disease, working your brain to slow or prevent its development is an option for everyone. And it’s free!

Previous research, including the Nun Study, which I wrote about in Just Think, has demonstrated an association between cognitive activity and the prevention of Alzheimer’s disease, but this is the first study to identify a physical explanation for what is happening in the brain as a result of cognitive activity.

In an interview with Science Daily, one of the paper’s authors, William Jagust, MD, said, "There is no downside to cognitive activity. It can only be beneficial, even if for reasons other than reducing amyloid in the brain, including social stimulation and empowerment....And actually, cognitive activity late in life may well turn out to be beneficial for reducing amyloid. We just haven't found that connection yet."

Surviving

The last several months I've been immersed in a six-part project on cancer therapy, a topic that is at once bleak and exciting. Targeted agents in development and genetic profiling for individualized treatment suggest a future of increasingly hopeful outcomes. Nevertheless, the million dollar question for people who receive a diagnosis of aggressive malignancy remains, How long have I got?

Clinical trials in these settings typically use median survival--overall survival or progression-free survival--as the measuring post by which to compare one treatment regimen to another or to placebo or observation. To review statistics 101, the "median" number in a series of numbers is the middle value, with half the numbers above and half the numbers below. For example, if 32 apples are distributed among 7 children, with one child receiving one apple, three children receiving four, two receiving five, and one receiving ten, the median number of apples is four. An understanding of median is important in thinking about survival data because the upper and lower range of numbers in the series doesn't change the median. If instead of 10 apples, the last child in the example above received 1,000 apples, the median would still be four. (In contrast, mean is the average of all the numbers in the series and mode is the most common). In cancer terms, if the median survival is one year, the survival for some is a few months, and for others, many years.

For Christmas 2007, my son gave me a book of essays by Harvard professor and evolutionary biologist Stephen Jay Gould called The Richness of Life (great title!). One of the essays, "The Median Is Not the Message," is about the hope inherent in statistics, contrary to popular belief. In 1982, Gould was diagnosed with abdominal mesothelioma, a particularly aggressive form of cancer with a median survival of eight months. He read everything he could about cancer, this cancer, and survival statistics. Once he realized, with relief, the extended possibility of survival beyond the median, he knew he had time to "think, plan, and fight." He flung his efforts into increasing his odds of landing at the far end of the survival range, which he succeeded in doing, living for 20 more years.

His essay explains in very understandable terms the good news he found through his analysis of statistics. It's worth a read if you have cancer, know someone with cancer, are afraid of cancer, or just want to have some practice looking at a negative situation from a positive point of view. You can find the essay in the anthology I mentioned or on numerous cancer advocacy sites, including here.

It is the day before New Year's Eve and so a more appropriate post on this day might be a hip-hooray for the fresh start ahead, or a musing on how the changing economy colors the outlook for the coming year, or even a preview of what I'll be serving guests as the clock strikes midnight. But I'll stay with this post anyway. After all, what better time to focus on the who-knows-what-is-possible streaming flare of life than hours before a new year begins.

~~~

Figure source: http://www.stat.psu.edu/online/development/stat500/lesson02/lesson02_02.html

A weekend away: brave new world

Have you heard of L’Abri Fellowship? It was started in Switzerland in the 1955 by Francis and Edith Schaeffer. They decided to open up their home, making a kind of retreat center for anyone who wanted to explore or study Christianity. In its first 20 years or so, its guests were primarily teenagers or young adults backpacking through Europe “to find themselves”, en route to Katmandu or some other specific or undefined destination. Now, there are multiple L’Abri houses around the world in additional to Switzerland (England, Australia, US, Germany, Sweden, Holland, Korea, and Canada) and guests are just as likely to be a 40-something taking time away from a job as a 20-something wondering what to do with his or her life.

This weekend, my husband and I attended the L’Abri annual conference held in Rochester, Minnesota. Although it was a bit of a trip south, it wasn’t far enough south for us to escape the 50 below wind chill that swept into Minnesota this past weekend. Fortunately, however, Rochester is a lot like Minneapolis in that much of the core city can be accessed through skyways or underground passageways.

It was our first L’Abri conference but I hope it won’t be our last. The two-day event drew about 700+ people from around the country--even from around the world--and was packed wih plenary and workshop presentations. The theme of the conference was “Living in a Brave New World” and focused on current trends in society, particularly in science. Speakers included theologians, writers, physicists, physicians, and others. It will no doubt take me longer to unpack all my notes, than it will to unpack my suitcase. The weekend was dense with things to think about.

Here’s the main thing I took home, however: Be a person who seeks truth, goodness, and beauty. What one person does, matters.

That may be exactly the encouragement I needed. Maybe it’s the encouragement you need as well.

Boil up another pot of tea

I just made myself a cup of tea and sat down at my computer to work. Opened up the National Library of Medicine website (final destination, Medline/PubMed) and saw this headline under "Current Health News": Tea Drinking Linked to Lower Ovarian Cancer Risk.

Clicked through to Reuter's story:

Woman who drink two or more cups of tea every day may cut their risk of ovarian cancer in half, a new study shows.

Both black and green teas are rich in antioxidant chemicals called polyphenols, which have been shown to block cancer growth in lab and animal studies, Susanna C. Larsson and Alicja Wolk of the Karolinska Institutet in Stockholm note.

The paper was published in the current issue of Archives of Internal Medicine: Tea Consumption and Ovarian Cancer Risk in a Population-Based Cohort.

This Scandinavian study was large; 61,057 women participated with an average follow-up of 15.1 years. As with all studies--even large ones--confounding factors must be considered. In this case, tea drinkers also weighed less and ate more fruits and vegetables. Even considering these factors, however, the effect of tea on lowering the risk of ovarian cancer was significant in itself.

My tea tastes good--regular Lipton with milk, no sugar--even better knowing its health benefit. A good friend of mine died of ovarian cancer; in a couple of days it will have been ten years ago. I'll think of her when I make my second cup.

Sure, I'll have seconds

A number of bloggers have been using the month of November as an opportunity to made daily declarations of gratitude. I've been following Julana's list. On this, the last day of November, I'm going to make a post of thanksgiving. And it's going to sound silly on the surface but upon further reflection I hope that you'll agree it's not.

I'm thankful for a good appetite.

Yes, it leads me to eat things I shouldn't eat. And yes, it puts me in the constant position of wishing the scale hit a lesser number when I stand on it. Yet, a good appetite is a profound gift.

Why did it occur to me, just now, to sing the praises of appetite?

Because I'm writing a paper on chronic kidney disease and in researching this paper I just read a study linking appetite to clinical outcome in patients with this disease. The risk of dying is 4 to 5 times greater in patients with a poor appetite compared with patients with a good appetite. Aside from the risk of death, patients with a poor appetite have a greater risk for hospitalization and report a lower quality of life compared with patients with a good appetite. The authors of this paper suggest that asking a simple question, "How's your appetite?", is a fairly accurate predictor of clinical outcome in these patients.

Appetite seems to be one of those things we have little control over. It's there in whatever degree that it chooses. From the perspective of this paper, appetite is truly a profound gift.

Now, I don't think this realization gives me license to honor my appetite by walking into kitchen and taking a handful of chocolate chips out of the Nestles bag but maybe just a few can't hurt.

The heart and justice

Justice is not often the object of study in a medical journal.

Kivimäki and colleagues just published a study on the health effects of justice at work. In a study of 6442 male British civil servants, aged 35 to 55 years and no heart disease at the beginning of the study, they demonstrated that justice at work is associated with reduced risk of heart disease. When adjusted for age and employment grade, data showed that employees who experienced a high level of justice at work had a 30% lower risk of new heart disease compared with employees who experienced a low or an intermediate level of justice.

According to the study’s authors, “An indicator of justice at work is whether people believe that their supervisor considers their viewpoints, shares information concerning decision-making, and treats individuals fairly and in a truthful manner.”

The level of justice in the workplace was assessed by a self-report questionnaire that asked the following questions (using a scale of 1 to 4, with 1 being “never” and 4 being “often”):
(1) Do you ever get criticized unfairly (reverse scored)?
(2) Do you get consistent information from line management (your superior)?
(3) Do you get sufficient information from line management (your superior)?
(4) How often is your superior willing to listen to your problems?
(5) Do you ever get praised for your work?

Job strain and effort-reward imbalance were also measured, using self-reported job demands, job control, efforts, and rewards. Higher job strain, and, to a lesser extent, higher effort-reward imbalance, were also associated with higher risk of new heart disease but the justice factor is unique among psychosocial work factors in that it is directly focused on managerial treatment and procedure.

The authors offer this conclusion:

Most people care deeply about just treatment by authorities. Just treatment may communicate status and value, whereas lack of justice may be a source of oppression, deprivation, and stress. Justice, equity, and altruism have been the drivers of benign developments in human societies according to a wide range of studies across a broad spectrum of disciplines. Our findings on [coronary heart disease], the leading cause of death in all Western societies, suggest that organizational justice is also a topic worthy of consideration in health research.

The study was published in the October 25 issue of Archives of Internal Medicine. You can read the article in full here.

Sylvia Plath in the pages of medicine

“Narrative medicine” is a trend in medicine that values the patient’s story. The term was coined by Rita Charon, M.D., Ph.D., Director of the Narrative Medicine Program College of Physicians and Surgeons of Columbia University. In an online publication of LitSite Alaska, Charon identifies the term as referring to “a medicine practiced with narrative competence and marked with an understanding of these highly complex narrative situations among doctors, patients, colleagues, and the public.” Narrative competence is the ability to hear and understand story, and in the context of medicine, it is the patient’s story that is of significance. Charon believes that reading and understanding literature is a way for physicians to learn to better understand their patient’s stories.

I was grateful to see evidence of the trickle-down influence of this movement as I began a new medical writing project yesterday. The first step in a new project is to review relevant medical studies and published guidelines. These are typically devoid of story but instead filled with statistics and demographics and methodologic analyses, etc etc. Yesterday, however, I read a report published by a national data system--surprisingly a government-funded national data system--that had literary quotes at the beginning of each chapter. How efficiently those quotes changed the entire feel of the document from that of a sterile repository of facts to one that was engaged in real life.

At the beginning of the chapter that told how many dollars were spent on this disease state and how many people will die despite all these dollars there was a quote from The Diary of Anais Nin,

“There are very few human beings who receive the truth, complete and staggering, by instant illumination. Most of them acquire it fragment by fragment, on a small scale, by successive developments, cellularly, like a laborious mosaic.”

At the beginning of the chapter that told demographic information about the patients who have this disease state there was a quote from The Ongoing Story by John Ashbery,

“A knowledge that people live close by is, I think, enough. And even if only first names are ever exchanged the people who them seem rock-true and marvelously self-sufficient.”

At the beginning of the chapter that told about how the heart may be affected by this disease state there was a quote from I thought that I could not be hurt by Sylvia Plath,

“How frail the human heart must be--a mirrored pool of thought. So deep and tremulous an instrument of glass that can either sing or weep.”

At the beginning of the chapter that told about children with this disease state there was a quote from Of Woman Born by Adrienne Rich,

“The mother’s battle for her child--with sickness, with poverty, with war, with all the forces of exploitation and callousness that cheapen human life--needs to become a common human battle, waged in love and in the passion for survival.”

At the beginning of the chapter that told about the nutritional support patients with this disease require there is a quote from Dubious Honors by M. F. K. Fisher,

“It seems to me that our three basic needs, for food and security and love, are so mixed and mingled and entwined that we cannot straightly think of one without the others. So it happens that when I write of hunger, I am really writing about love and the hunger for it, and warmth and the love of it and the hunger for it...and then the warmth and richness and fine reality of hunger satisfied...and it is all one.”

And there is more, one quote for each chapter.

My office is filled with many medical articles, treatment guidelines, association reports. This is the only document achieving a literary human dimension. A preface page included this statement: “Treating chronic disease requires a multitide of skills and a mind-set that will not allow adversity to fog our final vision.” Even that statement had a different flavor, a grander more human rally, than does the typical medical mandate “to optimize treatment thereby reducing morbidity and mortality.” More documents like this would be welcome additions to my small working library and to the healthcare community. Perhaps I will send this group my resume?