2008年10月28日 星期二

Chasing the secret of long life

Chasing the secret of long life


An old volume I recently picked up at a used bookstore in Tokyo contains an anecdote about Herman Boerhaave (1668-1738), a Dutch physician who became famous in Europe during his lifetime. The story concerns a certain unpublished manuscript owned by Boerhaave, which was discovered with its seal intact among his personal effects after his death.

The title translates as "the deepest secrets of medicine" in English, and the book was thought to contain the secret of longevity.

At auction, bids for the book rose higher and higher, even though nobody knew anything about the content. This episode shows how the human thirst for knowledge of good health and long life has been with us through the ages.

More than ever, people today eagerly lap up any health-related information. While we shouldn't fall for dubious or phony health tips, newspapers are full of stories about medical experts' opinions and research findings, such as a recent claim that drinking green tea prevents diabetes. Such stories apparently appeal to a large readership.

Being over 50, I am greatly interested in the recent news that drinking "seven cups of green tea a day" keeps diabetes at bay. For some time, however, my beverage of choice has been coffee because coffee drinkers are said to be at a lower risk of liver cancer.

Yet were I to start guzzling both green tea and coffee at teatime to "run after two hares," as the saying goes, I suppose my midsection would soon become bloated.

Just the other day, it was reported that elderly men in their 60s and 70s who are "somewhat chunky" are likely to live longer than their skinnier peers. Many people must have been greatly heartened by this news, but let's get this clear: If your bulk owes mostly to fat, and not muscle, you are actually at a greater risk.

Keeping healthy is a multidimensional commitment. We must beware of placing too much trust in any single theory or discovery, as it will only put us on an emotional roller coaster and wear us out.

Back to Boerhaave. The book was auctioned off at an exorbitant price, but the pages turned out to be blank.

The only words it contained were to the effect: "Keep your head cold, your feet warm, and your body relaxed. That way, you can laugh at all doctors."

I leave it up to each reader to decide whether Boerhaave was a sarcastic doctor or a wise observer of human nature.

--The Asahi Shimbun, Oct. 27(IHT/Asahi: October 28,2008)

2008年10月24日 星期五

placebo effect 醫生病人關係

placebo effect

Stories in the Service of Making a Better Doctor

Aaron Houston for The New York Times

Tia Harmon, a patient at Saint Barnabas Medical Center in Livingston, N.J., listens as Dr. Benjamin Kaplan reads from "Kitchen Table Wisdom: Stories That Heal," by Dr. Rachel Naomi Remen.

Published: October 23, 2008

The white-coated crowd with stethoscopes slung casually around their necks would have looked familiar to anyone who has attended morning hospital rounds. Resident physicians and medical students milled about, chatting animatedly, and at the appointed hour, the attending physician signaled to begin.

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Aaron Houston for The New York Times

Dr. Richard S. Panush

But instead of filing toward a patient’s room, the group at Saint Barnabas Medical Center in Livingston, N.J., settled into a conference room at the end of the hall, not to recite details of patient cases but to read “Empty Pockets,” a personal essay by Dr. Kevan Pickrel from The Annals of Internal Medicine. In the piece, Dr. Pickrel describes being unable to save a 36-year-old woman, then going to the waiting room to inform the woman’s family of her death:

“The youngest daughter sat on Dad’s lap looking at pictures in an outdoors magazine. The older sat watching her hands rest in her lap. [The] husband’s eyes lifted to me and met mine. I didn’t, couldn’t, say a word.... He turned back toward his daughters, a single father, and they lifted their eyes to his. As he drew a breath to begin, his eldest daughter knew.

After the reading, the attending physician, Dr. Sunil Sapra, looked up at the group assembled. “Do you identify with any of these situations?” he asked.

“Yes, it happens all the time,” a resident responded immediately. Others nodded in agreement, and one resident flicked a tear away.

The next morning, in a similar room at New York-Presbyterian Hospital in upper Manhattan, a group of obstetrics and gynecology residents gathered to read E.B. White’s short story “The Second Tree From the Corner.” Told from the perspective of an anxiety-ridden patient, the story ends with the main character finding meaning in his life and suddenly feeling liberated:

“He felt content to be sick, unembarrassed at being afraid; and in the jungle of his fear he glimpsed (as he had so often glimpsed them before) the flashy tail feathers of the bird courage.”

As the reading ended, one of the young doctors commented on how personally fulfilling it was to help her patients and how those feelings invigorated her, even after many hours of work. Other doctors in the room nodded in agreement.

While it has long been understood that clinical practice influenced the youthful writing of doctor-authors like Chekhov and William Carlos Williams, there is now emerging evidence that exposure to literature and writing during residency training can influence how young doctors approach their clinical work. By bringing short stories, poems and essays into hospital wards and medical schools, educators hope to encourage fresh thinking and help break down the wall between doctors and patients.

“We’re teaching the humanities to our residents, and it’s making them better doctors,” said Dr. Richard Panush, a rheumatologist and chairman of the department of medicine at Saint Barnabas.

The idea of combining literature and medicine — or narrative medicine as it is sometimes called — has played a part in medical education for over 40 years. Studies have repeatedly shown that such literary training can strengthen and support the compassionate instincts of doctors.

Dr. Rita Charon and her colleagues at the program in narrative medicine at Columbia University’s College of Physicians and Surgeons found, for example, that narrative medicine training offered doctors opportunities to practice skills in empathy. Doctors exposed to literary works were more willing to adopt another person’s perspective, even after as few as three or four one-hour workshops.

“You want people to be able to leave their own individual place,” Dr. Charon said, “and ask what this might be like for the child dying of leukemia, the mother of that child, the family, the hospital roommate.”

Over the last 15 years, an ever-increasing number of medical schools have begun offering narrative medicine to medical students. These courses often involve writing, reading and discussing works by authors as diverse as Leo Tolstoy, Virginia Woolf, Lori Moore and various doctor-authors. Students then explore the relevance of these texts, and their own writing, to their clinical work.

But until recently, few educators have attempted to bring such literary training into residency programs.

Residency is the most intense period of a young doctor’s life. The years spent squirreled away in hospitals and clinics are rich in clinical learning, but the wealth of that experience comes at the cost of free time.

And with time at a premium, residency program directors and clinical educators have been hesitant to add narrative medicine to their curricula, particularly since it has never been clear that such an addition would have any effect other than further overworking the trainees.

That could be changing.

For over a year now, Dr. Panush, a tall, bespectacled, soft-spoken man with the lean physique of a runner, has been systematically incorporating literature into the daily rounds of every one of the internal medicine residents at Saint Barnabas Medical Center.

As part of the Accreditation Council for Graduate Medical Education’s Education Innovations Project, Dr. Panush and his faculty colleagues bring poetry, short stories and essays to rounds each day and discuss them in the context of the patients they see. These daily discussions, supplemented by offsite weekly conferences, form the core of the residents’ narrative medicine experience.

One year into the program, Dr. Panush and his colleagues looked at the effect of these daily discussions on the residents and their patients. What they found were significant improvements in patient evaluations of residents and patients’ health and quality of life, from hospital admission to discharge.

A handful of other residency programs across the country have taken steps toward establishing narrative medicine training for their residents, including Vanderbilt University’s Department of Surgery and New York/Presbyterian Hospital-Columbia’s Department of Obstetrics and Gynecology. As with the program at Saint Barnabas, it has been the doctors within these departments who have initiated the workshops, sessions and lectures.

“As we improve the technology of medicine, we also need to remember the patient’s story,” said Dr. A. Scott Pearson, an associate professor of surgery at Vanderbilt University Medical Center.

To that end, Dr. Pearson has completed a pilot study examining the feasibility of incorporating narrative medicine into Vanderbilt’s surgical residency and has plans to make such training available eventually to all surgical residents at his medical center. Dr. Pearson believes that narrative medicine will not only help residents reflect on what they are doing and how they might do better, but may also aid surgical educators in teaching professionalism and communication skills.

“Narrative medicine changed my entire approach to medicine,” said Dr. Abigail Ford, a senior resident in obstetrics and gynecology at New York-Presbyterian Hospital/Columbia who studied under Dr. Charon as a medical student. “As a doctor you are really a co-author of patients’ experiences and need to hear their story and take it on.”

With her former professor’s guidance, as well as the support of Dr. Rini Ratan, the residency program director, Dr. Ford has initiated a narrative medicine program for her fellow obstetrics and gynecology residents. While the program is still in its first year, “we’ve always run over,” said Dr. Ford. “People have to be dragged away.”

“Our hope is to look at it in terms of physician empathy,” added Dr. Ratan, “Does it add anything? Does it prevent natural jadedness over the course of the busy training process? Does it prevent burnout?”

In the near future, Dr. Ratan and Dr. Ford also hope to begin doing the kind of patient outcome evaluations that Dr. Panush and his colleagues have begun.

“To do what we’re doing is pretty simple,” said Dr. Panush. “But the measurement stuff is harder. The program needs to be supported institutionally and internally.”

Despite such challenges, the effects of these programs are striking. Dr. Benjamin Kaplan, a second-year resident at Saint Barnabas, remarked on the transformation he saw in fellow resident physicians during the first year of the humanities program.

“Their management of patients changed,” Dr. Kaplan said. “They remembered to do things that I don’t think they would have otherwise done, like always talking to the family, gently touching patients, and continually explaining the course of treatment and what the doctors are thinking so patients know.”

And the time commitment? “It does get pretty busy,” Dr. Kaplan conceded. “But if you want to make time for it, you can. Spending a half hour a day to remember that we are all human, not just doctors or pharmacists or nurses or patients, is important enough that I think you should do it.”

Although it is still too early to determine the long-term effects of narrative medicine on doctors in training, residents were quick to note that certain essays, short stories and poems they have read on rounds continue to influence their work.

Dr. Ramesh Guthikonda, a second-year resident at Saint Barnabas, spoke about a poem called “When You Come Into My Room,” by Stephen A. Schmidt. In the poem, published in The Journal of the American Medical Association, a man struggling with chronic illness lists all that he believes a doctor meeting him should know:

“When you come into my hospital room, you need to know the facts of my life

that there is information not contained in my hospital chart

that I am 40 years married, with four children and four grandchildren....

that I love earthy sensuous life, beauty, travel, eating, drinking J&B scotch, the theater, opera, the Chicago Symphony, movies, all kinds, water skiing, tennis, running, walking, camping...

that I am chronically ill, and am seeking healing, not cure.”

The poem so affected Dr. Guthikonda that he began regularly asking his patients about their hobbies and families, and he enrolled in a Spanish class so he could learn to better pronounce their names. “My rapport with patients, especially with my Hispanic patients, was not up to the mark,” he said. “I never asked about the patients’ lives, about who they are. I am much more sensitive to those issues now.”

Reflecting on the changes in Dr. Guthikonda, Dr. Panush said, “We changed the way he thinks and does medicine. You can’t put a p-value on that.”

Have literary works made you a better caregiver or patient? Click here and join the discussion on the Well blog, “Combining Literature and Medicine.”

2008年10月23日 星期四

每天只要做五件簡單的事 長保健康

泰晤士報一篇文章報道,科學家說,每天只要做五件簡單的事情,就可以保持腦健康,減少精神疾患。 這些簡單的事包括整理花園,修理自行車,做飯等。 科學家們還建議,要保持身心健康,享受快樂人生有關鍵幾步,這幾步是: 保持同家人,朋友的聯繫﹔多活動,包括走路,跳舞,體育活動等﹔要善於注意到每天那些令人愉快的時刻﹔要不斷獲取新的知識﹔幫助別人和社區能增加你的滿足感。

October 22, 2008

Do five simple things a day to stay sane, say scientists

Simple activities such as gardening or mending a bicycle can protect mental health and help people to lead more fulfilled and productive lives, a panel of scientists has found.

A “five-a-day” programme of social and personal activities can improve mental wellbeing, much as eating fruit and vegetables enhances physical health, according to Foresight, the government think-tank. Its Mental Capital and Wellbeing report, which was compiled by more than 400 scientists, proposes a campaign modelled on the nutrition initiative, to encourage behaviour that will make people feel better about themselves.

People should try to connect with others, to be active, to take notice of their surroundings, to keep learning and to give to their neighbours and communities, the document says.

Its advice to “take notice” includes suggestions such as “catch sight of the beautiful” and “savour the moment, whether walking to work, eating lunch or talking to friends”. Examples of learning include mending a bike or trying to play a musical instrument.

“A big question in mental wellbeing is what individuals can do,” Felicia Huppert, Professor of Psychology at the University of Cambridge, who led part of the project, said. “We found there are five categories of things that can make a profound difference to people’s wellbeing. Each has evidence behind it.” These actions are so simple that everyone should aim to do them daily, she said, just as they are encouraged to eat five portions of fruit and vegetables.

Critics of the recommendation said that the Government and health professionals ought not to be prescribing individual behaviour in this way. “The implication is that if you don’t do these banal things, you could get seriously mentally ill, and that trivialises serious mental illness. What is happiness, anyway? It’s so subjective,” Claire Fox, director of the Institute of Ideas, said.

Although the report has no immediate policy implications, ministers will pay attention to it because Foresight is headed by the Government’s chief scientist, Professor John Beddington.

The project investigated ways of improving the nation’s “mental capital”, which Professor Beddington likened to a bank account of the mind. “We need to ask what actions can add to that bank account, and what activities can erode that capital,” he said.

Among the other issues it highlights is a strong link between mental illness and debt. Half of people in Britain who are in debt have a mental disorder, compared with just 16 per cent of the general population.

Rachel Jenkins, of the Institute of Psychiatry in London, who led this section of the report, said: “We’ve known for a while there’s a link between mental health issues and low income, but what more recent research has shown is that that relationship is probably mostly accounted for by debt.”

The report advocates more flexible working, days after Lord Mandelson, the Business Secretary, announced a review of government plans to extend such arrangements.

Cary Cooper, Professor of Organisational Psychology and Health at the University of Lancaster, a co-ordinator of the report, said: “People who choose to work flexibly are more job-satisfied, healthier and more productive.”

Steps to happiness

Developing relationships with family, friends, colleagues and neighbours will enrich your life and bring you support

Be active
Sports, hobbies such as gardening or dancing, or just a daily stroll will make you feel good and maintain mobility and fitness

Be curious
Noting the beauty of everyday moments as well as the unusual and reflecting on them helps you to appreciate what matters to you

Fixing a bike, learning an instrument, cooking – the challenge and satisfaction brings fun and confidence

Helping friends and strangers links your happiness to a wider community and is very rewarding

Source: Foresight report

2008年10月16日 星期四

Power of Pee Keeps Klitschko's Fists Pounding

From the Fringe | 15.10.2008

Power of Pee Keeps Klitschko's Fists Pounding

Medical practitioners of both the holistic and traditional varieties have long used urine for treatment purposes, but boxer Vitali Klitschko may have devised a brand new therapy with the help of his son's wet diapers.

While treatments with names like "the urine cure" and "urine therapy" tout the liquid's cleansing characteristics -- with some even praising it as a cure for nearly every malady -- Ukrainian boxer Vitali Klitschko had practical demands for the waste product.

He used his son's wet diapers to help keep his fists from swelling up after winning his WBC heavyweight title match against Nigeria's Samuel Peter, Klitschko told German mass-market daily Bild on Tuesday, Oct. 14.

"Baby wee is good because it's pure, doesn't contain toxins and doesn't smell," the 37-year-old boxer told the paper after winning the title bout on Saturday.

"I wrap diapers filled with my three-year-old son Max's wee around my fists," he said, adding that the idea originated with his grandmother. "The nappies hold the liquid and the swelling stays down."

DW staff (sms)

2008年10月11日 星期六

What’s the Healthiest Diet of All?

October 3, 2008, 11:33 am

What’s the Healthiest Diet of All?

Diners at an outdoor cafe in Corsica, France.Diners at an outdoor cafe in Corsica, France. (Ed Alcock for The New York Times)

What exactly do doctors mean by a “healthy diet”?

Many of us consider the Mediterranean diet to be the closest thing known to an ideal meal plan, rich in vegetables, fruits, legumes, cereals, fish, olive oil and, yes, a bit of red wine with meals. Compared to traditional American menu — high in red meat and in butter and other dairy products — the Mediterranean diet is lower in saturated fat, more varied and often more satisfying.

Decades worth of research also suggests that this way of eating is healthier. Many studies have documented reduced rates of heart disease and cancer among those adhering to a Mediterranean diet, compared to those eating more red meat and dairy-based regimens. Most of these studies have involved observations rather than actual intervention trials, however, and they have varied in size.

Now the British Medical Journal has published a systematic compilation of a dozen of the most methodologically sound of these observational studies, which included over 1.5 million people followed for up to eighteen years, analyzing cardiovascular consequences and some other important health outcomes. This large meta-analysis found decreased cardiovascular death as well as cancer mortality, and a lowered incidence of Parkinson’s disease and Alzheimer’s disease, in those following the Mediterranean diet versus those on other diets.

While such meta-analyses have limitations and cannot be considered as persuasive as large, randomized intervention trials, the new study further supports the idea that the Mediterranean diet can confer important health benefits.

Different diets abound, many even promoted by physicians. But it’s a mistake to think of a diet as a temporary measure; instead, it is a lifetime commitment to healthy choices. Need to lose weight now? Don’t rush. Take comfort in knowing that even a modest incremental reduction can confer significant health benefits, lowering your risk of heart disease or diabetes. Crash diets only set us up for “yo-yo” weight loss and regain.

Whatever eating habits you adopt must be sustainable over the long term. Many researchers regard this as the Mediterranean diet’s greatest strength. You can stick to it, and like it, year after year.

How sad, then, to learn that a diet that whose adherents were among the longest-lived in the world is now fading from view. The governments of Greece, Italy, Spain and Morocco have asked that UNESCO designate the Mediterranean diet an “intangible piece of cultural heritage.” But as The Times recently reported, fast food is proliferating across the Mediterranean region, threatening to propagate a U.S.-style obesity epidemic.

In Greece, three-quarters of the adult population is now overweight or obese, and at increasing risk for diabetes, heart disease and arthritis, among other maladies. “Much of the highly praised diet didn’t exist any more,” said a senior economist at the United Nations who conducted a recent survey of regional eating habits. ”It has become just a notion.” Rather than turning our backs on this traditional diet, the new data suggest we could all derive substantial health benefits from it.

[For some dishes with a Mediterranean flair, check out The Times' Recipes for Health. -- Eds.]