The Blog

Art Markman, Ph.D.: A Simplified Way To Achieve Your Goals

2012-05-28T11:40:53Z

For most of us, life is just too busy. It is hard to do everything you want and need to do in a day. If you're lucky, then your failures are not that systematic. One day, you get to the gym, but don't get to relax with a book. Another day, you get the shopping done, but don't clean up the kitchen. Those kinds of goal failures are fine. They just reflect that you have to make choices about what you are going to accomplish.

The real problem comes when your goal failures are systematic. If you consistently fail to go to the gym, then you don't accomplish the long-term goal of staying in shape.

Because everyone has some set of goals that they find difficult to achieve, there has been a lot of research focusing on how to get better at accomplishing the most difficult goals. One of the most effective techniques for helping you to achieve your goals is the "implementation intention," which emerged out of research by Peter Gollwitzer and his colleagues.

An implementation intention is a specific plan to achieve a goal. The idea is that many of your goals are defined too abstractly to be able to carry them out. "Going to the gym," for example, is a very general statement. When you create an implementation intention, though, you create specific steps to achieve the goal and to avoid obstacles. You might say that you are going to go to the gym on Tuesdays and Fridays at 4 p.m. You think through specific obstacles like what you will do if a meeting comes up during your gym time, or if you are just feeling too tired to go. These implementation intentions are effective, because they help you to recognize when and where you will take actions that allow you to succeed.

An interesting paper by Amy Dalton and Stephen Spiller in the Journal of Consumer Research suggests that there are limits to the effectiveness of implementation intentions. In particular, implementation intentions get less effective as the number of goals you are trying to achieve goes up.

In one study, the authors asked people to commit to either one new goal (like reading a book for pleasure, calling a friend, or eating a healthy meal each day) or six new goals. They either committed themselves to the goal, or they formed a specific implementation intention. Then, for five days, the researchers asked people which goals they fulfilled. They also asked people for their commitment to the goals. At the end, they asked people how difficult they thought it was to achieve these goals.

When people were focused on one goal, the implementation intention helped people to achieve their goal. They were much more likely to pursue the goal when they formed an implementation intention than when they just committed to the goal. When they were focused on six goals, though, they actually were slightly less likely to achieve their goals when they formed an implementation intention than when they did not.

This finding reflected that when there was only one goal, people were more committed to that goal and thought it would be less difficult to achieve the goal when they formed an implementation intention than when they did not. When there were six goals, though, the implementation intention made people feel that satisfying the goals would be difficult to achieve, and so the plans actually decreased people's commitment to the goals.

The main message of this work is that you have to be careful not to overwhelm yourself with the details when working toward a difficult goal. Implementation intentions have both a positive and a negative part. On the positive side, they help you to figure out exactly how to add goal-related activities to your life. On the negative side, they can also make it clear how difficult it is to achieve the goal.

If you find yourself overwhelmed by the details, then try to scale back your expectations. Even small steps toward a goal are better than no steps at all. For example, if you cannot get to the gym every day, try to get there at least once a week. After you add these new behaviors to your routines, you may find ways to increase your commitment to that goal later.

For more by Art Markman, Ph.D., click here.

For more on success and motivation, click here.

Lisa Firestone: Memorial Day: An Opportunity to Reach Out to Veterans

2012-05-27T15:50:02Z

Memorial Day was established as a day for honoring and acknowledging all of the men and women who have died serving the United States. And in this past decade, there have been many. For those who we've lost, we can offer remembrance. But now is also a time to call attention to the thousands of veterans who've returned from battle whose lives are still at great risk. And for these men and women, we can certainly do even more.

In an eye-opening article in the Daily Beast on veteran suicide, it was reported:

The number of U.S. soldiers who have died by their own hand is now estimated to be greater than the number (6,460) who have died in combat in Afghanistan and Iraq." The article pointed out that about 18 veterans commit suicide each day in the United States and reported data from the National Violent Death Reporting System showing that "male veterans have a twofold increase in death by suicide over their civilian counterparts and that female veterans are three times as likely to kill themselves as their civilian counterparts.

I recently spoke to Jan Kemp, RN, Ph.D., VA National Suicide Prevention Coordinator. She said that although we as a nation are making huge strides, encouraging veterans to seek help and raising community awareness, we have a long way to go:

The holiday is an excellent time to sit back and think about what we can do as individuals to reach out to vets, be a friend, be there for them, encourage them to get services. Friends and family are the people on the ground who can notice the signs and identify that the person needs help and encourage them to get it.

Jan mentioned to me that calls at the of the National Suicide Prevention Lifeline are continuing to increase, partly due to the lifeline's recent publicity and their community awareness campaign, but also because more soldiers are coming home. A growing population of vets, many who have spent years at war, is now learning that help is available, and it is okay to seek it. Lives can be saved, which is why it is so important to get the lifeline number and website out to those who need it.

Getting veterans to the help they need is imperative. It is also valuable for us to have an understanding of the many factors that lead to increased suicide risk among veterans. A deployment into a warzone can be traumatic beyond words. The horrors of what veterans have witnessed and what they have done can linger in their memory and impact them long after their service has ended. Even when their actions were in self-defense, in response to an order, or in the name of a cause they believed in, on a human level any act of violence can leave a person with post-traumatic stress.

Another factor involves the stress of multiple deployments. The more times a person is exposed to this trauma, the more hopeless he or she can begin to feel. While soldiers may be able to imagine "getting lucky" and surviving once or twice, they often feel a strong sense that the odds are against them by the time they're deployed for the third time. This leaves them into a state of hyper-vigilance, a state of fear and distrust that persists beyond deployment. After facing constant stress and threat to their lives, how then do they psychologically re-adapt to a safe environment?

A feeling of isolation is another strong factor contributing to increased suicide risk. The uniquely traumatic events veterans experience can leave them feeling distanced from the families and friends they come home to. No one close to them has necessarily seen, heard, or felt what they have. Their sense of alienation is exacerbated when the valuable skills the military equipped them with don't easily translate into their home lives. This period of distance and disconnect can be dangerous for a veteran, who must reestablish their connection to the world around them in order to feel like they are not alone.

In addition, physical injury and stress can take its toll and increase risk for self-harm in veterans. According to the Military Suicide Research Consortium:

Among the U.S. military personnel who were injured while taking part in Operation Enduring Freedom and Operation Iraqi Freedom, between 10 and 20 percent suffered traumatic brain injuries ... Research has shown that Veterans with traumatic brain injury are significantly more likely than other Veterans to die by suicide.

Even those who are fortunate to leave a war without a severe physical injury must deal with the many mental challenges that result from combat. The warrior mentality that is encouraged in men and women in the military and their acquired ability to hurt or kill others requires a level of desensitization that can be difficult to emerge from and cope with when soldiers return to their "normal" lives.

Suicide and homicide are both acts of violence. Being capable of one makes a person increasingly capable of the other. That is why we must offer a way for individuals returning from war to break from the warrior mentality and reconnect with themselves. We must re-sensitize them by allowing them to feel their emotions and experience empathy, compassion, and peace.

The military has been taking action to implement programs and collect data to address this crisis and offer veterans the services they need. One measure that would be strongly beneficial would be for the military to conduct multiple aggressive assessment screenings over time of returning military personnel. In the meantime, we as individuals, family, friends, neighbors, co-workers, and associates can take actions now that can help save a life. We can do this by recognizing the warning signs for suicide in veterans and supporting them getting the services they need. We can reach out to veterans and their families, and work together to de-stigmatize struggles with mental health. In doing so, are taking action to protect the lives of those who have been deeply wounded in their effort to protect us.

The Veterans Crisis Line connects veterans in crisis and their families and friends with qualified, caring Department of Veterans Affairs responders through a confidential toll-free hotline, online chat, or text. Veterans and their loved ones can call 1-800-273-8255 and Press 1, chat online http://www.veteranscrisisline.net/, or send a text message to 838255 to receive confidential support 24 hours a day, 7 days a week, 365 days a year.

For more from Dr; Lisa Firestone, visit at PsychAlive.org

For more by Lisa Firestone, click here.

For more on Memorial Day, click here.

For more on mental health, click here.

Need help? In the U.S., call 1-800-273-8255 for the National Suicide Prevention Lifeline.

Dave Helfert: Memorial Day: Honor the Fallen, Remember the Living

2012-05-27T15:24:16Z

In 1868, the nation set aside the last Monday in May to remember and honor those who had died in her battles. Memorial Day was originally called Decoration Day, and people placed wreaths and bouquets on the graves of the fallen from the Civil War.

One hundred forty-four years later -- seven declared or undeclared wars and dozens of incursions, clashes and confrontations since Lee's surrender at Appomattox Courthouse -- it's still fitting and proper to honor the fallen. But it is every bit as fitting and proper to honor those who have been scarred, visibly or invisibly, by combat. Many combat wounds don't show, and yet the invisible scars can be every bit as painful, every bit as debilitating, last as long and hurt as deeply as any physical injury.

Today it's called post-traumatic stress disorder, or PTSD. It's been around as long as war itself. Greek soldiers in the Battle of Marathon in 490 B.C. experienced it on the battlefield and after they'd returned home. In our own country's history, thousands and thousands of Civil War veterans suffered from "soldier's heart." In WWI, WWII and Korea, it was called shell shock or combat fatigue. During the Vietnam War, the military didn't want to admit that anything was wrong. So lots of retuning vets went undiagnosed and were just considered weird or screwed up when they came home.

PTSD wasn't acknowledged and listed in Diagnostic and Statistical Manual of Mental Disorders until 1980. The International Statistical Classification of Diseases and Related Health Problems, the authoritative medical classification list published by the World Health Organization to code diseases, signs and symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, did not list PTSD until 1992.

And now we have new generations of Americans who have witnessed the abject horror of war and its effect on even the strongest human spirit. They understand the brain-numbing reality of living every hour of every day knowing you could be killed or maimed at almost any time. They understand that to survive in war, you have to be able to kill other people and make incredible deals with yourself to make it okay. They understand that you have to demonize the enemy, even minimize their humanity and turn them into less than people because that makes it easier to kill them. They may have experienced the shock and white-hot anger at losing a buddy. And they assuredly understand that, when snipers have your unit pinned down, or IEDs are detonating, or when you're in the middle of a firefight, all the speeches about building a democracy or keeping the world safe from terrorism are bilious BS. They understand that, in war, the world doesn't extend beyond them and their immediate comrades.

Then, at some point, they come home, where nobody understands any of this. No one knows what they've been through, what they've seen, what they've been called on to do. All they can do is try to forget and put it all behind. It is not easy. And many never do.

"I am blind to beauty for I have seen the ugliness of war, my heart discard my soul's an open sore, my spirits broken and my body is not well, for I have seen the smoke and fire and passed through the gates of hell, I've held a dying man grasping for last breath and been surrounded by the taste of death and the smell of fear, I've buried both friend and foe in fields where no crops will ever grow, there is no honor in taking of a life, and I have done so with my rifle and my knife, and I do not sleep well at night, for in my dreams I still fight, and the enemy I see is a soldier... and it's me."

-- Kevan Lyons

This Memorial Day, honor those who have fallen in service to the nation. They have given the last full measure and they surely deserve our respect and gratitude. But take just a minute to honor those who fought in our wars and lived. For many, their battles are far from over.

For more by Dave Helfert, click here.

For more on Memorial Day, click here.

For more on PTSD, click here.

David Volpi, M.D., P.C., F.A.C.S.: Is Daytime Sleepiness The Root Of Learning And Behavior Problems In Children?

2012-05-27T14:35:55Z

For months now, I have been writing about the studies that are being published -- seemingly by the month -- linking obstructive sleep apnea (OSA) to more and more medical conditions, including hypertension, heart disease, mood and memory problems.

The latest research didn't surprise me, but it did upset me more than usual -- because it concerns our children, and the negative effects that poor sleep can have on their ability to pay attention, learn and control their behavior.

On May 1, the results of a study by Penn State researchers was published showing that children who have learning, attention and/or behavior problems may be suffering from a condition known as excessive daytime sleepiness (EDS) -- even if tests indicate that they are getting enough sleep at night.

For the study, the researchers conducted sleep testing on 508 children, and asked their parents to report if their child seemed excessively sleeping during the day. Then, the children were divided into two groups: children with excessive daytime sleepiness, and those without EDS. The results, published in the May 2012 issue of Sleep, showed that the children in the parent-reported EDS group were more likely to have "neurobehavioral" problems, including behavior/conduct problems, attention/hyperactivity and poorer performance in learning speed and working memory than children without indications of EDS.

What surprised the researchers was that even if a child was in the EDS group, few also showed signs of short (not enough) sleep when tested. As a result, the researchers did not associate short sleep with any of the learning, attention and behavior problems.

So, what is causing these children's extensive daytime sleepiness if they are getting enough sleep (at least on paper)? Like in adults, perhaps it is not just the length of sleep time, but the quality of sleep that determines restorative rest, or not.

A New York Times article from April 16, 2012 entitled "Attention Problems May Be Sleep Related" also examined the relationship between children's sleep quality and the ability to pay attention at school. The article was on another recent study called "Sleep-Disordered Breathing in a Population-Based Cohort: Behavioral Outcomes at Four and Seven Years," published in the Official Journal of the American Academy of Pediatrics.

What I found disturbing about this article was that it pointed out that many cases of attention deficit hyperactivity disorder (ADHD) in children may have been misdiagnosed -- that the cause of behavior such as moodiness and hyperactivity might in fact be due to obstructive sleep apnea (OSA) or other sleep disorder, which is causing sleep deprivation in the child. Worse, the drugs diagnosed for the ADHD are probably making the child's symptoms worse!

This should be a call to arms for parents, caretakers, teachers and the medical community. If you know of a child suffering from sleep deprivation and/or extensive daytime sleepiness, and the symptoms that result, such as behavioral and learning problems... Speak up and suggest they get tested for a sleep disorder first.

Impairment due to EDS in daytime cognitive and behavioral functioning can have a significant impact on children's development. This is not to say that ADHD cannot be a true cause, but misdiagnosis of anyone -- especially a child prescribed drugs -- should not be tolerated.

Stay aware of the child's behavior; look for clues, such as inattentive behavior and obesity, take a child's "sleepy" complaints seriously... and then say something. You could be the reason a child's neurobehavioral challenges are properly diagnosed and treated, leading to better behavior, greater ability to learn and a happier child.

Read the abstract of the report, "Learning, Attention/Hyperactivity, and Conduct Problems as Sequelae of Excessive Daytime Sleepiness in a General Population Study of Young Children."

For more by David Volpi, M.D., P.C., F.A.C.S., click here.

For more on sleep, click here.

Mark Hyman, MD: How One Social Experiment Helped 15,000 People Lose 250,000 Pounds

2012-05-27T14:26:33Z

Click here to read Part I of the story.

Part II of my TEDMED 2012 conference...

One day I found Pastor Rick Warren from Saddleback Church in Southern California in my office wanting to get religion about health. After his appointment we went to dinner and over a bowl of cabbage and beet soup, I asked him to tell me about his church -- being a Jewish doctor from NY, I didn't know much about evangelical churches.

He told me his church had 30,000 members and they met every week in 5,000 small groups to study, support and grow together.

It wasn't a mega-church, it was thousands of mini-churches. And the lightbulb went off in my head -- here was a chance to test out this idea of peer support for creating health.

I said, why don't we put together a healthy living curriculum and deliver it through these small groups? Rick said yes because he had recently baptized 800 church members and after about the 500th one, he said to himself, "Wow, we are a fat church, and I am fat, and we need to do something."

We didn't need highly-trained health experts -- except in designing the program...

So a little more than a year ago, with Rick and Dr. Oz and Dr. Amen -- a Christian, a Jewish doctor and Muslim doctor, which sounds like the beginning of a bad joke -- we launched The Daniel Plan, a social experiment to see if community support was more effective than medication or conventional medical care for treating and reversing disease and creating health.

The Daniel Plan (after Daniel, the prophet from the Bible who resisted the king's temptation of bad foods) is a wellness program delivered through small groups in the church.

We thought a few hundred people would sign up. In the first week, 15,000 people signed up and over the last year they have lost an estimated 250,000 pounds -- or the equivalent of 10 tractor-trailer trucks loaded with soda. Thousands of people and many churches around the world signed up.

In fact, I met recently with church leaders in Atlanta and Bernice King, Martin Luther King, Jr.'s daughter, who said that she thinks disease is a form of violence -- and health is a basic human right. She said that health is a form of non-violence to yourself and that she wanted to make this part of the King Center's curriculum on nonviolence.

And our social experiment worked.

We got biology to change by using the principles of functional medicine -- the science of systems medicine, of network medicine, the science of creating health, through lifestyle-based interventions that optimized our biological networks.

But we got behavior to change by using community and the power of positive peer pressure and social networks.

Not only did they lose a quarter of a million pounds, but they also used less medication, and many stayed out of the hospital or didn't need to go to the doctor as much. And the program was free. And people reported more energy, better sleep, better blood pressure, better mood, and even better skin and a better sex drive.

One man told me last year he was in the hospital four times and on nine medications, and this year he stayed out of the hospital and is only on one medication. People lost 125 pounds, 90 pounds, 80 pounds, got off insulin for diabetes and high blood pressure medication -- it was like a gastric bypass without the pain of surgery, vomiting and malnutrition.

And those who did the plan together lost twice as much weight as those who did it alone.

E.O. Wilson says in his new book, The Social Conquest of the Earth that it is our drive to join a group that makes us human. It is the longing to belong -- and the power of peer pressure can be a force for both good and evil. It can drive war and violence, but it can also be a force for healing.

Here was the big insight for me: The community was not just a delivery system for health education. The community was part of the cure and the group was the medicine.

So what did we do? We created an interactive curriculum delivered through multiple media -- online education, videos, articles, recipes, webinars -- all done in small groups and community events. We did this at Saddleback by changing the culture: Pastor Steve, who was born again, again went from serving ribs and donuts for breakfast to being a health champion, grabbing donuts out of the mouths of the men in his small group.

Over a thousand people showed up and volunteered to be health champions for their groups. We changed what was served at Bible breakfasts, the menus in the refinery and even what people served in their homes and their small groups. People learned to create health together -- to shop, cook, eat, exercise and play together.

We didn't treat disease. We didn't create a weight-loss program.

We taught people self-care, and combining that with caring for each other, they created a small miracle -- something heath care or health care reform has not been able to achieve.

In the most unlikely place, a large church, we demonstrated that a community-based solution is more effective in treating and reversing chronic disease than our modern health care system. People helped each other create health.

I think this is the seed of a bigger possibility. In every home, community, school, workplace and faith-based organization, there are health champions waiting to be asked to show up and to help each other to take back our health.

We have a vision to scale this to a billion people and turn health care upside down.

And this is possible not just in rich countries. Peers for Progress created pilot programs in the poorest of countries to treat diabetes in Cameroon, Uganda, Thailand and South Africa based on peer support. The peer support group models were more effective than conventional medical care for improving the health of diabetics, and health care costs decreased tenfold.

So after the meal of the skinny Haitian chicken and the beet and cabbage soup, I thought, what if we could tackle this problem not one by one by one in the doctor office and clinics, but by the tens of millions in people homes, and churches, and schools, and workplaces?

What if we could take the 36 percent of Americans who are eligible for work but NOT working, and create a Health Corp like President Kennedy's Peace Corp, or a call to action that would be the equivalent of getting a man on the moon by the end of the decade?

And create millions of community health workers, engage our world's latent health champions because they are out there in every community, in every organization of peers? People helping people: That, with a little training, has been proven to produce better results than doctors or our health care system for the worst problems of our era.

Maybe, I thought, this isn't a medical problem like an infection or broken bone -- maybe chronic diseases like diabetes and obesity are social diseases and we need a social cure.

Maybe it is the power of each one of us supporting each other that will help us all take back our health.

Acute disease can be left to the hospitals, but creating health and healing of chronic disease seems to happen best in the community -- with people helping people where each one of us lives, where we eat, cook, learn, work, play and pray.

That is where health happens.

When I was at Paul Farmer's mountain clinic in Haiti, there was a plaque in French that said, "The happiest man is the one who makes others happy."

An old African proverb says that if you want to travel swiftly travel alone, but if you want to travel far, travel together.

Let's all do this together!!

To help facilitate your journey to health, click here to join my online community.

Now I'd like to hear from you...

What do you think we can do to take back our health?

If you already are part of a community, would you share your experiences?

Please leave your thoughts by adding a comment below.

To your good health,

Mark Hyman, MD

Mark Hyman, M.D. is a practicing physician, founder of The UltraWellness Center, a four-time New York Times bestselling author, and an international leader in the field of Functional Medicine. You can follow him on Twitter, connect with him on LinkedIn, watch his videos on YouTube, become a fan on Facebook, and subscribe to his newsletter.

For more by Mark Hyman, M.D., click here.

For more on personal health, click here.

Jeffrey Levi: Safety First, Yet the Facts Hurt: How Injury Prevention Can Save Lives

2012-05-25T22:56:06Z

We can save hundreds of thousands of lives by enacting, enforcing and supporting injury prevention policies and activities. A recent report released by Trust for America's Health (TFAH) and the Robert Wood Johnson Foundation (RWJF) found that many injury prevention activities have been scientifically shown to reduce harm and deaths, for instance:

Seat belts saved an estimated 69,000 lives from 2006 to 2010;
Motorcycle helmets saved an estimated 8,000 lives from 2005 to 2009;
Child safety seats saved around 1,800 lives from 2005 to 2009;
The number of children and teens killed in motor vehicle crashes dropped 41 percent from 2000 to 2009; and
School-based programs to prevent violence have cut violent behavior among high school students by 29 percent.

Unfortunately, the report, "The Facts Hurt: A State-By-State Injury Prevention Policy Report,", also found that 24 states scored a five or lower on a set of 10 key indicators of steps states can take to prevent injuries. Some findings include:

29 states do not require bicycle helmets for all children;
17 states do not require that children ride in a car seat or booster seat to at least the age of 8;
31 states do not require helmets for all motorcycle riders;
34 states and Washington, D.C. do not require mandatory ignition interlocks for convicted drunk drivers;
18 states do not have primary seat belt laws;
44 states scored a "B" or lower on a teen dating violence law review by the Break the Cycle organization; and
14 states do not have strong youth sport concussion safety laws.

In addition, the report identified a set of emerging new injury threats, including a dramatic, fast rise in prescription drug abuse, concussions in school sports, bullying, crashes from texting while driving and an expected increase in the number in falls as the Baby Boomer generation ages.

Injuries -- including those caused by accidents and violence -- are the third-leading cause of death nationally, and they are the leading cause of death for Americans between the ages of 1 and 44. Approximately 50 million Americans are medically treated for injuries each year, and more than 2.8 million are hospitalized. Nearly 12,000 children and teens die from injuries resulting from accidents each year and around 9.2 million are treated in emergency rooms. Every year, injuries generate $406 billion in lifetime costs for medical care and lost productivity.

Our report, which was developed in partnership with leading injury prevention experts from the Safe States Alliance and the Society for the Advancement of Violence and Injury Research (SAVIR), concludes that millions of injuries could be prevented each year if more states adopted additional research-based injury prevention policies, and if programs were fully implemented and enforced -- yet lack of national capacity and funding are major barriers to states adopting these and other policies. The report also notes that funding for injury prevention for states from the U.S. Centers for Disease Control and Prevention (CDC) averages only $0.28 per American -- and has dropped 24 percent from fiscal years 2006 to 2011 -- and only 31 states have full-time injury and violence prevention directors, which limits injury prevention efforts.

If we're going to lower the number of injuries in America, we need to redouble efforts. We need to adopt, implement and enforce evidence-based approaches, and increase public awareness of ways we can all keep ourselves and our families safer.

While individuals are responsible for their own safety and protecting themselves and their families from injuries, experts have found that policies and laws, from child safety seats to poison control centers, can help Americans make healthier and safer choices.

The federal government took an important step by including injury prevention as one of the seven priorities in the National Prevention Strategy (NPS): America's Plan for Better Health and Wellness, released in 2011. The NPS brings 17 federal agencies together for the first time to move the nation from a focus on sickness and injury to prevention and wellness. The NPS can help bring new emphasis to the importance of injury prevention and increase momentum to build win-win partnerships between public health and other sectors. For instance, motor vehicle policies and programs involve working with transportation officials, experts and members of industry, while violence reduction efforts can involve community organizations, social services, education, law enforcement, the judicial system and other areas. These collaborations are another key to successfully reducing injuries.

Also, without continued research, we could backslide on the progress we've made in reducing injury in the U.S. We need to invest in more research to continue to improve the policies we already have in place and find innovative solutions to the new threats we face, like the increase in prescription drug abuse and texting while driving.

As our report concludes, right now, the facts do hurt -- but if we adopted, implemented and enforced more evidence-based strategies to prevent injuries, millions of Americans could be spared from injuries each year.

For more by Jeffrey Levi, click here.

For more healthy living health news, click here.

Susan Blumenthal, M.D.: Overcoming Stigma and Improving Mental Health in America

2012-05-25T20:45:00Z

Written in collaboration with Deepa Kannappan

Although an estimated 44 million adults and 13.7 million children in America have a diagnosable mental disorder each year, the issue of mental health remains surrounded by stigma and misunderstanding. This May marks the 63rd anniversary of Mental Health Month, but the problem of mental illness requires greater attention as a major 21st-century public health challenge. Among the millions of affected Americans, fewer than half get help, even though 80 to 90 percent of mental disorders are treatable using medication and other therapies. These disorders take an enormous toll on individuals and families, as well as society as a whole. In addition to the significant human impact, mental illness has enormous economic costs. Treatment for depression alone is estimated to cost $83 billion yearly, while lost productivity among those affected by mental disorders impacts the well-being of businesses, individuals and their families.

Despite the prevalence of mental illness, the stigma is so profound that many consider mental health problems to be the result of personal character flaws rather than real illnesses, like heart disease or diabetes. Addressing mental illness as a serious 21st-century public health challenge means:

Focusing on specific age, racial/ethnic and gender-related risk factors
Improving public education and reducing stigma so that more people are willing and able to seek help
Strengthening the role of primary care doctors in screening for mental illness and referring patients to mental health professionals
Creating a comprehensive therapeutic approach that combines culturally competent, psychotherapeutic approaches with medication, if indicated.
Providing parity for health insurance coverage for mental illness

Mental disorders include anxiety disorders (e.g., post-traumatic stress and obsessive-compulsive disorders), mood disorders (i.e., depression and bipolar disorder), eating disorders including anorexia and bulimia, addictive disorders (such as alcoholism), and personality disorders. However, not all demographic groups are affected equally by various categories of mental disorders. In an NIH survey of American adults conducted in 2008, age, sex and race variables were analyzed among those who had serious mental illness. Females were more affected than males, younger Americans more than older Americans, with varying results across ethnicity. Understanding the impact of gender, age and ethnic/racial differences is important in designing programs to reduce the prevalence of mental illnesses and in targeting effective interventions.

Sex differences in mental illness take several forms, including in the prevalence of the types of disorders that impact men and women. For instance, depression and PTSD are more common in women while other disorders, like alcoholism and antisocial personality disorder, are more common in men. The causes for these gender differences are in part linked to biological factors, such as the impact of hormones. There are also other risk factors for mental disorders that disproportionately affect women, including violence, low socioeconomic status, income inequality, subordinate status within society and the stress of multiple roles including work and child care responsibilities. Given these circumstances, women are more likely to suffer from specific mental illnesses, such as depression and anxiety, and are also 50 percent less likely to use mental health services than men.

Children and young adults are also at high risk for developing mental disorders, with 13 percent of youth in the United States under the age of 18 meeting the criteria for one of the six most prevalent mental illnesses: generalized anxiety disorder, panic disorder, eating disorders, depression, attention deficit hyperactivity disorder and behavioral disorders. Although there is some controversy about whether disorders like ADHD and bipolar disorder are over-diagnosed in American children, youth are at a very real risk for mental health problems that can be exacerbated by environmental factors, such as abuse and neglect, a stressful learning environment and media influences that propagate ideal body types.

Understanding the factors that contribute to mental illness is the first step; the second is to shatter the stigma that surrounds seeking help for mental illness, a stigma that is very pervasive in most cultures. The result is low rates of detection and treatment. Only 2 in every 5 people experiencing a mood, anxiety or substance abuse disorder seek assistance in the year of the onset of the illness.

A strategy to decrease this stigma is to educate the public that mental disorders have a biological and neurological basis, and are not a character flaw or personal weakness. Another strategy is increased outreach to affected individuals and their families. Public health education campaigns should encourage people to recognize signs of mental illness in their loved ones and urge them to seek help. Campaigns that engage celebrities, athletes and community members who have been affected by a mental illness to come forward as role models for those who are silently struggling can be very helpful.

Low rates of diagnosis are confounded by the fact that doctors may fail to detect mental illness even when patients seek help. Primary care physicians are not trained to be mental health providers, and few mental health providers work in the primary care setting. Thus, less than half of those who meet diagnostic criteria for mental disorders are identified by their physicians. A recent study found that primary care providers fail to recognize almost two-thirds of their patients who have a mental disorder. Doctors are often unable to identify the diagnostic criteria for a majority of the most prevalent mental illnesses. Primary care physicians and nurses must be better educated in the early detection of mental illness and be able to refer patients to qualified mental health professionals. Mental illnesses often complicate treatment of other illnesses like cancer or chronic diabetes, in part because the patient has lost emotional resilience. By detecting mental illness early, primary care professionals have the potential to dramatically change the quality of life of the patient and decrease the effects of co-morbidity with other illnesses.

Treatment for mental disorders can include a combination of psychotherapy, medications, social support and lifestyle changes. Support from family, friends and the community is vital. Additionally, behavioral interventions, including exercise, improved nutrition, sleep and stress reduction, can contribute to overall health and enable individuals to better manage their emotional problems.

Mental Health Month is a time to raise awareness about the public health problem of mental illness. Targeting at-risk populations, decreasing the stigma surrounding mental disorders, integrating mental health into primary care settings and providing comprehensive treatment strategies will promote more effective diagnosis and treatment of these illnesses in the future.

Image source: NIMH

Rear Admiral Susan Blumenthal, M.D., M.P.A. (ret.) is the Public Health Editor of the Huffington Post. She is also the Director of the Health and Medicine Program at the Center for the Study of the Presidency and Congress in Washington, D.C., a Clinical Professor at Georgetown and Tufts University Schools of Medicine, and Chair of the Global Health Program at the Meridian International Center.

Dr. Blumenthal served for more than 20 years in senior health leadership positions in the Federal government in the Administrations of four U.S. Presidents, including as Assistant Surgeon General of the United States, the first Deputy Assistant Secretary of Women's Health, as a White House Advisor on Health, as Chief of the Behavioral Medicine and Basic Prevention Research Branch and as Chair of the Health and Behavior Coordinating Committee at the National Institutes of Health. Admiral Blumenthal has received numerous awards including honorary doctorates and has been decorated with the highest medals of the US Public Health Service for her pioneering leadership and significant contributions to advancing health in the United States and worldwide. Named by the New York Times, the National Library of Medicine and the Medical Herald as one of the most influential women in medicine, Dr. Blumenthal is the recipient of the 2009 Health Leader of the Year Award from the Commissioned Officers Association and was named a Rock Star of Science by the Geoffrey Beene Foundation. To learn more about Susan Blumenthal, M.D., visit 4globalhealth.org

Deepa Kannappan, an undergraduate at Stanford University, serves as a Health Policy Intern at the Center for the Study of the Presidency and Congress in Washington, D.C.

For more by Susan Blumenthal, M.D., click here.

For more on mental health, click here.

Leann Reynolds: Changes to Mental Health Diagnosis Could Impact Caregivers

2012-05-25T19:48:15Z

How mental health professionals diagnose their patients could be changing and therefore affect patients, families, and caregivers after 2013.

According to the American Psychiatric Association:

The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders that is used by mental health professionals in the United States. It is intended to be applicable in a wide array of contexts and used by clinicians and researchers of many different orientations (e.g., biological, psychodynamic, cognitive, behavioral, interpersonal, family/systems). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has been designed for use across clinical settings (inpatient, outpatient, partial hospital, consultation-liaison, clinic, private practice, and primary care), with community populations. A wide range of health and mental health professionals, including psychiatrists and other physicians, psychologists, social workers, nurses, occupational and rehabilitation therapists, and counselors can use it. It is also a necessary tool for collecting and communicating accurate public health statistics.

Anticipated changes to the DSM (now commonly referred to as the DSM-5) will go into effect in May 2013 and have been generating a fair amount of controversy.

"It's complicated for family members," said Ken Duckworth, Medical Director of the National Alliance on Mental Illness. "They want to make sure people are getting help."

Changes to the DSM-5 will be the first to the manual in 17 years, and might affect everything from research and treatment to insurance coverage.

One of the more hotly-debated changes is in the autism diagnosis. The proposed changes include a recommendation for a new category called autism spectrum disorder which would incorporate several previously separate diagnoses, including autistic disorder, Asperger's disorder, childhood disintegrative disorder and pervasive developmental disorder not otherwise specified.

"For some people it may enlarge their access to treatment," said Darrel A. Regier, M.D., M.P.H. and Director for the Division of Research at the American Psychiatric Association and Vice-Chair of the DSM-5 Task Force and Director of the American Psychiatric Institute for Research and Education.

Across websites devoted to autism and in other public forums, people have been expressing fear and concern that eliminating specific autism diagnoses might eliminate access and treatment for loved ones. The goal of the proposed changes is have more accurate diagnoses -- not just of autism, but many mental disorders -- and therefore better treatments.

Considering that studies have shown that family caregivers are at a higher risk for depression than non-caregivers, it's also important to note proposed changes to how major depression is treated by clinicians.

"I think caregivers are at a increased risk for depression because of the persistent stress level they are under, " said Dr. Regier.

The DSM-5 will highlight a link between depression and anxiety, a combination that can mean a patient is at an increased risk for developing a "treatment-resistant illness" and higher risk for suicide. "The DSM does not specifically have treatment guidelines," said Dr. Reiger. "It helps clinicians recognize what is clinically meaningful when prescribing a course of treatment."

To learn more about the DSM-5 proposed changes, visit the site www.dsm5.org. If you are a caregiver and need support, contact the Homewatch CareGivers in your area.

For more by Leann Reynolds, click here.

For more on mental health, click here.

Stuart F. Quan, M.D.: Is This The Key To Solving The Obesity Epidemic?

2012-05-25T13:36:12Z

There is an epidemic of obesity in this country affecting all ages, both genders and all ethnic groups. Thus, the report "Accelerating Progress in Obesity Prevention: Solving the Weight of the Nation" from the prestigious Institute of Medicine, adds to the decibel of beating drums calling for national action. However, close examination of the document raises a significant concern. Importantly, the report promotes the roles of increased physical activity and better nutrition as cornerstones of a strategy to combat obesity, but what about sleep?

A search of the document finds the word "sleep" written only four times, and all of these are in reference to sleep apnea. Did the authors of this report ignore the accumulating data implicating sleep deficiency as an important contributing factor to development of obesity? Moreover, did the Institute of Medicine ignore their own previous report, "Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem," in which they cite evidence linking sleep loss to obesity? Unfortunately, the answer appears to be "yes."

What are the lines of evidence linking insufficient sleep to obesity? First, there is general agreement that time spent sleeping has declined over the past 30 years. This roughly approximates the rise in obesity. Second, a number of general population studies demonstrate that obesity is more common among those who sleep fewer than six hours per night. Furthermore, short sleep durations also are predictive of future weight gain. Third, basic research shows that short sleep durations increase levels of a hormone that stimulates appetite and simultaneously reduces the levels of a hormone that reduces appetite. Fourth, night shift workers generally sleep less than day shift workers but on average weigh more. Finally, on a personal level, have you felt hungry after staying up all night? I have, and my guess is that many of you have as well. Perhaps this is the best evidence of all linking inadequate sleep to obesity.

With the "weight" of the evidence implicating sleep deficiency as a risk factor for obesity and the indisputable fact that we should be spending one-third of our lives sleeping, can it be denied that sufficient sleep is the third pillar of health along with good nutrition and regular physical activity? Why the Institute of Medicine failed to come to this conclusion is unclear to me. However, the fight against obesity will be difficult to win unless all obstacles are addressed. A golden opportunity may be lost unless America recognizes that more sleep equals less weight.

For more by Stuart F. Quan, M.D., click here.

For more on sleep, click here.

Leslie Spry, M.D., FACP: Kidney Disease: To Screen or Not to Screen? That Is the Question

2012-05-24T20:15:42Z

When it comes to screening for various diseases, an ounce of prevention was always thought to be worth a pound of cure. Recently, this old adage has been called into question. While potentially lifesaving, many health screening tests and procedures come at great emotional, physical and financial cost. At what point do these costs outweigh the benefits? Or vice versa? From the lens of a kidney doctor, where does screening for kidney disease fit into this larger picture? Should everyone be routinely screened or should screening be targeted to specific groups? Do the benefits of screening for kidney disease outweigh the costs?

The answer is both yes and no. Yes, there are many significant benefits of screening and early detection of kidney disease, but no, not everyone should be or needs to be screened.

It is recommended by the National Kidney Foundation that we screen everyone who has a high likelihood and/or is at increased risk of developing chronic kidney disease. This means that anyone who has high blood pressure, diabetes or a family history of chronic kidney disease should be screened. Diabetes and high blood pressure damage the kidneys over time. Often there aren't any physical symptoms associated with this kidney damage, so people with either of these conditions should be tested for kidney disease on a regular basis. While population-wide screening is not currently recommended, as the number of people with these risk factors spiral higher, the gap between those at risk and the general population narrows. We're talking about screening 1 in 3 Americans, or roughly 74 million who are at risk because of hypertension and/or diabetes.

When detected early, chronic kidney disease (CKD) can be slowed, and often more serious complications can be prevented. Many CKD patients, especially those with diabetes and heart disease, may be able to delay or avoid going on dialysis or ever needing a kidney transplant when kidney disease is detected and managed early on.

Additionally, as we age, the kidneys tend to work less effectively. If you are over 60 years old, you have a higher rate of developing CKD. While some decrease in function is normal, often people don't realize that even in the elderly population kidney function should be monitored over time to ensure that the kidneys are working properly. If you have heart or peripheral vascular disease (hardening of the arteries), you also have a greater risk of developing CKD. If you are African American, Asian, Hispanic, American Indian or Pacific Islander, then you also have a greater risk of developing chronic kidney disease. Obesity in the United States is rising rapidly and also increases the risk of CKD.

How do you screen for kidney disease?

There are two simple tests that are quick, easy and routinely performed to screen for chronic kidney disease: a blood kidney function test for creatinine and a kidney damage test for protein in the urine.

1. Creatinine is a waste that healthy kidneys filter out of the blood. The creatinine level in the blood reflects how well the kidneys are filtering these wastes and can vary depending on age, race and body size. The serum creatinine (blood) level is used to estimate how well the kidneys filter. The estimated glomerular filtration rate or eGFR is a number that you can think of as a percentage of how well your kidneys are functioning. Above 90 is considered normal and below 60 for three or more months is chronic kidney disease.

2. Protein in the urine is an early sign of chronic kidney disease. Persistent amounts of protein in the urine (proteinuria) indicate kidney damage. Normal is less than 30 milligrams of albumin (a type of protein) per gram of urinary creatinine. Greater than 30 milligrams per gram is abnormal. If there is an abnormal level of protein in the urine, it indicates that when filtering wastes from the blood, the kidneys are relegating protein to the "discard pile" rather than recycling it back into the body. The protein then leaves the body in the form of urine, which is why this test can detect kidney damage.

Together, these two screening tests determine how well your kidneys are filtering wastes from the blood and whether products that should remain in the body, such as protein, are being leaked into the urine. Because these are relatively non-invasive, inexpensive tests and because early detection can prevent further kidney damage, I and the National Kidney Foundation recommend that all people with risk factors be screened for chronic kidney disease.

To screen or not to screen: What's the bottom line?

If you have any of the risk factors mentioned above, you have a 1 in 3 chance of developing chronic kidney disease. It is very likely that you are either part of this 33 percent or know someone who is. If so, get screened to make sure your kidneys are working as they should be and to prevent further kidney damage!

Ask your doctor for these tests during your next visit or attend the National Kidney Foundation's free kidney health screening program called the Kidney Early Evaluation Program (KEEP). KEEP provides free testing in communities across the country for those at risk of developing chronic kidney disease

For more by Leslie Spry, M.D., FACP, click here.

For more health news, click here.

Jean Fain, L.I.C.S.W., M.S.W.: Lose Weight, Gain Body Confidence? Not Necessarily, Says Purdue Researcher Sarah Mustillo

2012-05-24T19:18:40Z

It ain't necessarily so what so many dieters say -- that when they lose weight, they'll gain body confidence. So concludes a new study about the lingering stigma of obesity in the Journal of Health and Social Behavior. While overweight black girls did feel better about themselves when they lost weight over the course of the study, overweight white girls did not.

After analyzing 10 years of data on more than 2,000 black and white girls from the National Growth and Health Study, Purdue sociology researcher Sarah Mustillo can't say exactly why the effects of obesity-related stigma lingered for the white girls, but not the black. That's a subject for future study.

What the good sociologist can say: The black girls' self-esteem bounced back when they lost weight in early adolescence. However, when the white adolescent girls lost weight, their self-esteem remained flat. What's more, despite their lower body mass index, both groups continued to have negative body perceptions. In other words, the body image of both the black and white study subjects got stuck in time

"Despite changes in their relative body mass," Mustillo said, "we found that obese black and white teen girls who transitioned out of obesity continued to see themselves as fat."

I filed these intriguing findings for future reference, but I couldn't stop wondering: What is it about our culture that makes it so darned hard for girls to have good body image? Why, in fact, does bad body image plague America's great, multi-generational sorority?

To answer these and other questions, I decided to do what I usually do -- pick the brain of this compassionate mind for illuminating insights. I am also going to make my phone interview with this body image researcher the first in a new blog series on changing bad body image for good. What follows are questions and answers from my recent long-distance chat with Mustillo.

Q. Everyone talks about body image, but what is it exactly? What's your best working definition?

A. There are a lot of different definitions of body image. The working definition I use is an individual's perceptions, thoughts and feelings about her body, and how they're shaped through interactions with others and within a larger societal context.

Q. What moved you to explore body image in teen girls?

A. If the current national movement to end childhood obesity is successful, we can anticipate many young people moving from obese into the normal weight range, which will result in better physical health. I wanted to know if the same thing would happen for psychological health.

Q. What's the story behind the study? Did you struggle with bad body image as a kid?

A. The truth is I was a skinny girl. I didn't struggle with weight, nor did I really realize that some people wanted what I had. At the time, being thin and curvy was the ideal. I was too busy focusing on the fact that I wasn't curvy to be happy about being thin.

Q. Your conclusion is surprising, especially for dieters who believe that if they could just lose weight, they'd gain body confidence. What surprised you most about your findings?

A. People who lose weight may gain body confidence, it just may take longer than what one might think. We only followed these girls for a short period of time. Maybe if we would have followed them for another year or two or three, we might have seen an increase. My fear is if it [gaining body confidence] doesn't happen soon enough, people might lose the motivation to stick with it [losing weight]. What surprised me most was definitely the body-image finding -- that these girls continued to see themselves as heavy. Even as their bodies were changing, their perceptions of their bodies were not changing. To me, it speaks to the fact that the ideal is truly unobtainable. Even if they were getting closer, they still saw it as out of reach.

Q. How do you understand why black girls felt better about themselves after losing weight, but not white girls? What's the cultural difference?

A. There is evidence that black girls may be more accepting of different body sizes than white girls. At the same time, self-esteem still appeared to be tied to weight for the black girls. Because when they transitioned out of the obese range, their self-esteem improved, but their body image didn't change very much. To me, that says there's less of a link between body image and self-esteem among black girls than white girls. But that's something that requires a whole lot more research to understand.

Q. You're a sociologist. What is it about our culture that makes it so hard for women of all ages to have good body image?

A. Body image is so tied up with our overall sense of self. So when we look in the mirror and feel deficient, or look at another woman and feel "less than," it isn't just about body. It's about a deeper sense of unworthiness, and that just gets expressed in the body. You know, if I look at another woman and think her hair is so much nicer than mine or whatever, pick a body part, it's likely that she's got nicer hair. But it's also likely that I think that woman is better than me in other ways -- nicer than me, smarter than me, a better mother than me. It's not really about the body. It's about a deeper sense of feeling less than, or in competition with, other people. That goes hand-in-hand with our culture emphasizing individuality, independence, and that life is a popularity contest. We're in constant competition with each other, which encourages us to be critical of others and to be critical of ourselves.

Q. If weight loss doesn't improve body image, what does?

A. On a fundamental level, compassion for ourselves and others, and connectedness with others, might improve body image. I try to see myself the way I see my children -- beautiful, precious, incredible beings. To me, that's self-compassion. In terms of connectedness with others, it's helpful to remember that underneath all our physical differences, we're all emotional beings with needs and insecurities. If we can see other people with that same sense of compassion, then that could reduce the [sense that] life is a popularity contest. But that's hard enough for grown women to achieve, much less for teenage girls. On a more practical level for teenage girls, deemphasizing physical appearance and emphasizing other aspects of who they are helps. For example, there are studies that show girls who have a strong sense of identity in a role, like musician or athlete, have better body image because they locate more of their sense of self in that role than in what they look like.

Q. Do you think it's really possible to significantly alter body image?

A. I do. I just don't think it's as simple as doing some self-help exercises and being done with it. It's such a bigger societal issue. It needs to be addressed on several levels.

Q. What else needs to be done?

A. In a nutshell, I would like to see more work on racial differences and the cultural context of what defines ideals, how those ideals get transmitted to girls, and how that affects self-esteem. People always point to the media [as the source of white girls' body ideals], but what about black girls? Are they getting it from the media as well, or are there other sources? Also, I'd love to see more research done on ways to combat stigma in this area -- obesity -- and others.

Q. What's next for you and your research team? Are you already hard at work on a new study?

A. Of course! We are finishing a follow-up study on the same group of girls that examines parents' and friends' fat-labeling on mental health. In other words, the long-term effects of being told "You're fat!" by your parents or your friends, and how that affects mental health.

Q. A recent Canadian study on body image, self-compassion and self-esteem showed what my clients have shown me -- that more than self-esteem, greater self-compassion is associated with better body image. Any interest in studying the effects of self-compassion-enhancing techniques on body image?

A. I think that would be a fascinating study! I would guess that greater self-compassion is associated with better body image, and that better body image is associated with better self-esteem. I would bet that you're right -- that it starts with self-compassion and ends with feeling better about yourself.

Photo credit: Purdue University photo/Mark Simons

Jean Fain is a Harvard Medical School-affiliated psychotherapist specializing in eating issues, and the author of "The Self-Compassion Diet." For more information, see www.jeanfain.com. If you know anyone who has changed bad body image for good, tell me about them in the Comments section. This blogger is in search of future profile subjects as well as effective body-image programs.

For more by Jean Fain, L.I.C.S.W., M.S.W., click here.

For more on emotional wellness, click here
.

David Crews: More Evidence That Chemicals Are Changing Who We (And Our Children And Grandchildren) Are

2012-05-24T14:55:00Z

Not so long ago a colleague and I wrote on The Huffington Post about the potential health dangers of the thousands of "endocrine-disrupting" chemicals that are pervasive in our environment. Our hope was that we could nudge, in some small way, the forthcoming decision from the FDA on whether to ban BPAs in food and beverage containers.

Unfortunately the FDA didn't see the research in the same way we did. They chose to ignore what seems plain to us, that these chemicals are transforming our bodies and minds, and that we should err on the side of caution in exposing ourselves to them. As we wrote:

There is a long scientific history showing a link between exposure to endocrine disruptors and reproductive disorders such as infertility and early puberty. Furthermore, the evidence is growing that the damage is much more widespread. In studies of animals, both in the lab and in the wild, these chemicals have been shown to increase the risk of various cancers, to contribute to obesity, and to influence the activity of neurotransmitters in the brain. In fact, there are even hints that exposure to the chemicals may have something to do with the dramatic rise in autism and mental disorders over the past few decades.

This week another colleague and I published the results of a study that shows, for the first time, how an individual's ancestor's in utero chemical exposure, coupled with stress in that individual's own life -- generations later -- can combine to alter behavior even more dramatically than either kind of exposure does on its own. The paper appears in this week's issue of the Proceedings of the National Academy of Science.

It is a model, in other words, of how this is likely to be working in the real world, where it's not one exposure to one chemical that's likely to be determinative of a disease or a condition or a behavioral tendency. Life rather is a complex series of exposures -- to different chemicals, better or worse nutrition, varying degrees of stress, etc. -- that cumulatively change the patterns in how our genes are expressed. And those "epigenetic" changes alter our predispositions to different health and behavioral outcomes.

Our experiment was a proof of principle study. We subjected rats to a "two-hit" scenario. There was an in utero exposure to vinclozolin, which is a common fungicide used on fruits and vegetables. Then we let the rats reproduce and looked at how their great-grandchildren responded to stress during adolescence -- the second hit -- when they became adults. This was in comparison to a control group of rats whose ancestors weren't exposed to the fungicide or to the stress.

What we found was striking. Even before they were stressed, vinclozolin-imprinted and control mice performed significantly differently on a number of standard tests that measure anxiety, emotionality, and social responsiveness (they were also overweight, though that's a story for another time). But if they were also stressed as adolescents, those differences were in some cases exacerbated later in adulthood.

On one test, for instance, the stressed-out, vinclozolin-imprinted males were significantly more interested in spending their time with other rats than their control counterparts, who were more willing to split their time between socializing and exploring. It was as if, after the double whammy of ancestral exposure and the stress in their own adolescence, the affected males became more needy.

It's not difficult, nor is it inappropriate, to make the connection between results like these and one of the big questions that's been haunting our society for the past few decades: Why are so many mental health disorders on the rise?

We haven't proved that chemical exposure is at the root of increases in autism, bipolar disorder, anxiety and depression, and similar conditions. My guess is that we'll eventually discover a significant connection with at least some of these conditions, but we don't know yet.

What we do know with increasing confidence, however, is that chemical exposure is changing our brains, and that those changes are being passed on to our descendants. Not all of those changes are likely to be beneficial.

Maybe next time around, the FDA will take note.

This post has been updated since its original publication.

Steven Kurlander: Health Industry Scrambling to Comply With Revised HIPAA Privacy and Disclosure Rules

2012-05-23T21:00:25Z

The U.S. Department of Health and Human Services (HHS) is on the verge of implementing stricter privacy rules under The Health Insurance Portability and Accountability Act of 1996 (HIPAA) that will result in expanded and more stringent privacy and security requirements in the health and insurance industries and will allow patients to obtain a report detailing who has access to their confidential health information.

In February 2009, President Obama signed into law the American Recovery and Reinvestment Act (ARRA), which included a subsequent provision known as the Health Insurance Technology for Economic and Clinical Health Act (HITECH) that increased compliance responsibilities for health providers to provide augmented administrative, physical, and technical safeguards and documentation and policy changes in the storing and dissemination of client information under HIPAA.

The new Omnibus final rule, which is now under review by the Congressional Office of Management and Budget, will require increased security tracking requirements, provide for standardized breach notification to clients, and increased compliance enforcement for electronic protected health information. One big change in HIPPA privacy and security requirements will be that HIPAA rules will also now apply to business associates, including subcontractors, of the health provider. Originally, the rules only applied to the entity itself.

According to Ryan Morrissey, CTO of Applied Business Technologies of Delray Beach, Fla., a leading provider of call center software and platforms specifically designed to meet the increase HIPAA and HITECH regulations, health providers and those now covered by HIPAA under the new rules are working diligently to be ready to begin issuing privacy reports to customers once the Omnibus Rule takes effect, to take measures to ensure HHS audit compliance, and to increase their sophistication in monitoring and training their employees to otherwise meet the new guidelines.

"We have seen a great uptick in our HIPPA call center compliance business. More and more, call centers are increasing efforts to establish rigorous standards and to deploy HIPAA compliant call recording platform with the proper controls to monitor and evaluate call center representatives. These systems help in securing Protected Health Information in this evolving regulatory environment," said Morrissey.

HIPPA was passed by Congress with the intent to protect the privacy rights of individuals with regard to their confidential medical records. While health providers were required to keep medical information confidential, they were not obligated under HIPAA to inform patients who have accessed their information. When these changes are implemented by HHS, Americans will be able to the right to get a report from their medical providers or insurance companies detailing who has electronically accessed their protected health information.

In tandem with the proposed implementation of these new regulations, HHS has begun performing on-site compliance audits to promote conformity and review by covered health providers to HIPAA and HITECH privacy mandates.

If a covered entity is in violation, HHS can impose harsh sanctions, including an imposition of a $100 per violation penalty up to $50,000 per incident that can accrue up to $1.5 million in a calendar year; seek an injunction to stop the violations; and criminally prosecute offenders for knowing violations.

Violation of HIPPA can be costly. In February 2011, Cignet Health of Prince George's County, Md., was fined by HHS $4.3 million for violations of the HIPAA Privacy Rule.

The completion of the approval process for these HIITECH act regulations that amend the HIPAA privacy security and enforcement rules is expected to take place by the end of 2012.

"This proposed rule represents an important step in our continued efforts to promote accountability across the health care system, ensuring that providers properly safeguard private health information," stated OCR Director Georgina Verdugo in May 2011. "We need to protect peoples' rights so that they know how their health information has been used or disclosed."

Mark Britton: Humanizing the Doctor-Patient Relationship, Online

2012-05-23T18:48:05Z

Every one of us has gone through the agonizing experience of an exam room visit where a physician takes notes on our condition but offers little measure of warmth or personal exchange. We wait until they complete their written assessment, utter a few indistinguishable words, and make their exit without so much as a well wish. While most physicians are committed caregivers, establishing an inviting bedside manner can be more art than science.

And yet, a physician's bedside manner is one of the most important factors when it comes to patient reviews. According to a recent survey conducted by my company, Avvo.com, a doctor's willingness to listen, answer questions, and explain conditions -- was the top factor cited in 43 percent of positive online patient reviews. This far outranked the physician's demonstrated knowledge, which was cited in just 10 percent of positive reviews.

This underscores the notion that the days of merely taking the proverbial "doctor's orders" have long since passed. Today's patients are savvy, knowledgeable, and empowered. The internet provides a plethora of health information, and patients are accessing that information to take a more active role in their healthcare decisions. They are also using the internet to find new doctors for themselves and family members. According to the same survey, over 60 percent of respondents cited patient reviews as a primary influencer when selecting a new doctor online. This ranked slightly behind disciplinary history as an important factor for consumers when considering and comparing medical professionals.

Physicians, too, are getting savvier when it comes to social media. According to a recent Manhattan Research report, 60 percent say they use or want to use social networking to engage with their patients and enhance their reputation. Without question, doctors can use social media to "humanize" themselves with their current and prospective patient base by engaging with patients through online Q&A forums, using tools like Facebook and Twitter to participate in conversations, and ultimately being more accessible to patients outside of the now eight-minutes-on-average appointment time.

While the internet will never -- and should never -- replace a patient's in-person interaction with his or her doctor, it has created an unprecedented level of access to information about various symptoms and conditions, and also about the doctors themselves. It's critical that patients do their homework to find a doctor who not only has the best credentials, but who is also going to offer the kind of personal care they are seeking.

Mark Britton is the founder and CEO of Avvo, a free online resource that rates and profiles 90 percent of all doctors and lawyers in the U.S.

For more by Mark Britton, click here.

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Philip Lee Miller: Let's Revolutionize Prostate Cancer

2012-05-23T16:54:46Z

It is time. We need to rationally approach prostate cancer with new tools. Imaging first -- biopsy last.

In 2004 Dr. Thomas Stamey, Chief of Urology at Stanford, published a seminal journal article in the Journal of Urology, heralding the end of the PSA era. He had been known as "the father of the PSA." This was not greeted with great applause. He concluded that PSA testing was not an accurate measure of prostate cancer. In subsequent years, he has admitted the correlation coefficient between PSA testing and prostate cancer is approximately 20 percent. That is less than even odds that an elevated PSA equals prostate cancer. (Vigorous sex can raise your PSA up to 40 percent.)

Men are in constant fear of an elevated PSA and its implications. It's like watching the Dow. But the approach has been too slow to evolve.

Let me give you the best example. Women typically have an annual mammogram -- often followed by an ultrasound (it should be the opposite). If a suspicious mass is found, a wire-guided biopsy is performed. This is very targeted and limited only to the specific area of interest. A positive biopsy is now most commonly followed by a lumpectomy. The story then becomes complicated.

For men, the approach is backwards, and medieval. A suspicious digital rectal exam, followed by an elevated PSA (greater than 4.0) will inevitably demand a prostate biopsy. Fifteen years ago this would have been a "four core" sample. Four blind stabs. But over the interval there has been a tendency to increase to eight cores, then 12 cores and now 16 cores. Blind stabs through an area that cannot be sterilized. This can frequently cause infection, bleeding and pain.

It is time for this approach to come to an ignominious end.

We now have a far more sophisticated approach -- endo-rectal MRI scans with spectral analysis. The first and foremost was located at UC San Francisco. The most prominent center is now located in Thousand Oaks, Calif.

A PSA greater than 4.0, followed by a suspicious a digital rectal exam, can be referred for an endo-rectal MRI. No biopsy. The endo-rectal MRI has high specificity. Any suspicious lesion is accurately localized and graded with a "Gleason score." The key characteristic is "gland confined." This means that the tumor is intra-capsular. These are slow growing tumors. We need perspective.

If the MRI is positive, then an image-guided biopsy with no more than one to four cores is obtained under local anesthesia with considerably less pain and fewer complications. There is no reason why men are not routinely referred for these MRI scans, thus bypassing prostate biopsies.

Why is this not done? Routines. Medical algorithms. Reimbursement patterns. Surgeon training. Community "standard of care" nonsense.

There was a time 40 years ago when the time-honored Halsted radical mastectomy approach to breast cancer was finally questioned and a new era of lumpectomy was ushered in. This was only after a few brave individuals questioned the wisdom and necessity of "time-honored" radical procedures.

The time for a new approach for men has now come. But you must be persistent and seek a new course. You must be educated and demand from your physician/urologist that do not want (or need) a biopsy. You want the endo-rectal MRI with spectral analysis first.

This seismic shift could literally revolutionize the approach to prostate cancer and decrease the unneeded and unnecessary procedures and algorithms that follow. Did Warren Buffet need therapy?

We have seen the formulation of "task force recommendations" that are confusing the issue. Current recommendations, which make no sense, state all men greater than 65 should not be PSA tested and younger than 65 be PSA tested with caution.

Benefits [of PSA testing] seemed to be limited to men younger than 65 years. Treating approximately 3 men with prostatectomy or 7 men with radiation therapy instead of watchful waiting would each result in 1 additional case of erectile dysfunction. Treating approximately 5 men with prostatectomy would result in 1 additional case of urinary incontinence. Prostatectomy was associated with perioperative death (about 0.5%) and cardiovascular events (0.6% to 3%), and radiation therapy was associated with bowel dysfunction.

Conclusion: Prostate-specific antigen-based screening results in small or no reduction in prostate cancer-specific mortality and is associated with harms related to subsequent evaluation and treatments, some of which may be unnecessary.

But it is a misunderstanding of the specificity and variability of the PSA, which is not based on imaging studies. Serial PSA values are essential. It is the velocity curve that determines the possibility of prostate cancer. You don't stop testing. You learn how to more accurately profile the extent and aggressiveness of disease.

Send this blog to all your friends and loved ones. You can effect this paradigm shift. You deserve a 21st-century approach to this disease.

Philip Lee Miller, MD
May 9, 2012

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