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An Unusual Island with Unusual Results

The New York Times article, “The Island Where People Forget to Die,” is provocative.

It describes the island of Ikaria, a place known for unusual longevity. The case is made for multiple environmental determinants causing this. They include diet and exercise, but most importantly it would appear that a unique focus on harmony, relatedness, and relationships within the island community positively impact health.

The story of an Ikaria native, Stamatis Moraitis, is particularly intriguing. After moving and building a family in America for several years, he was diagnosed with cancer in 1976 and the doctors estimated he had nine months to live. With little hope to fight the cancer, he moved back to his native island to be buried among his ancestors.

“At first, he spent his days in bed, as his mother and wife tended to him. He reconnected with his faith. On Sunday mornings, he hobbled up the hill to a tiny Greek Orthodox chapel where his grandfather once served as a priest. When his childhood friends discovered that he had moved back, they started showing up every afternoon. They’d talk for hours, an activity that invariably involved a bottle or two of locally produced wine. I might as well die happy, he thought…

Six months came and went. Moraitis didn’t die… The years passed. His health continued to improve. He added a couple of rooms to his parents’ home so his children could visit. He built up the vineyard until it produced 400 gallons of wine a year.

Today, three and a half decades later, he’s 97 years old — according to an official document he disputes; he says he’s 102 — and cancer-free. He never went through chemotherapy, took drugs or sought therapy of any sort. All he did was move home to Ikaria.” Read More…

The traditional values and lifestyle described in the article are threatened on Ikaria, and are rare elsewhere. We suspect you will pass this on. Consider reading some of the many comments as well.

 

Drug Distributors Pressured to Reduce Narcotic Painkiller Shipments

Over the past few months, the DEA has tried a variety of different tactics to battle our painkiller epidemic.

From arresting hundreds of doctors, cracking down on pill mills, and investigating pharmacies, it’s most recent attempt has large drug distributors rattled.

The New York Times reports that after honing in on Florida and Ohio, the DEA is now putting pressure on other pharmaceutical distributors nationwide.

Earlier this year, the agency charged drug distributor Cardinal Health for violating it license to sell controlled drugs. Since then, Cardinal no longer does business with a dozen pharmacies in Arizona, California, Nevada, and Oklahoma and the number is growing.

The article notes that the pressure has pushed distributors to create a nationwide shipment reduction to pharmacies and doctors who order a high volume of narcotic pain killers.

“We had a strong anti-diversion system in place, but no system is perfect,” Cardinal Chairman and Chief Executive told the Times.

Since then, they have strengthened their criteria and  have also  created a committee that evaluates pharmacies that order large amounts of narcotic drugs.

Another major distributor, AmerisourceBergen, recently disclosed that it also faces a federal criminal inquiry into its oversight of painkiller sales.

The DEA’s crackdown on pharmacies and big distributors like Cardinal and AmericsourceBergen have shown that the agency is taking a much more aggressive approach to ending our nations painkiller issue.

However, doctors and pharmacies are critical of the way distributors have abruptly cut them off from their supply. One California pharmacist argued that his pharmacy specializes in pain patients which would explain his high volume orders.

“The drug distribution system is a sprawling one that involves about 800 companies, which range in size from a few giants like Cardinal to hundreds of small firms. For wholesalers, the markup on medications can be small, sometimes a few pennies a pill. But with billions of pills sold annually, the profits can be big. Narcotic painkillers are now the most widely prescribed drugs in the United States, with sales last year of $8.5 billion.”

There is also added incentive to sell Oxycontin and other narcotic painkiller because of their addictive properties and because street value on the black market is as much as $80 per 80-milligram dose.

However, while the DEA is implementing new tactics against distributors for failing to notify the agency of a “suspicious order” from a pharmacy or other customer, it does not share those reports with officials in the state where the pharmacy is based.

After the New York Times had asked for the agency to disclose the number of such reports it received annually, they declined saying, the agency considered such statistics “law enforcement sensitive” information.

In response, the Times has filed a Freedom of Information Act request seeking that data. Read More…

 

Is Alzheimer’s Diabetes of the Brain?

By Vanessa Radatus

A timeline of a healthy brain vs. a brain with advancing Alzheimer plaques

If you knew that processed foods, sugar and starchy carbohydrates would cause Alzheimer’s, would you stop eating them for good?

The sad truth is that more than one-third of Americans are obese and the average person consumes a staggering 156 pounds of added sugar per year, according to the U.S. Department of Agriculture. But is the standard American diet affecting more than just our waistline?

Recent research studies have indicated that the link between processed foods and sugar and the development of Alzheimer’s could be much closer than we thought.

While the exact cause of the disease has not been proven, Dr. Suzanne DeLaMonte, a researcher at Brown Medical School found that the connection between poor brain function and memory loss could be a form of diet-induced diabetes – coined Type 3 diabetes after the 2005 study.

New York Times columnist Mark Bittman sheds new light on the discovery in his article, “Is Alzheimer’s Type 3 Diabetes,” explaining how Alzheimer’s may well be classified as Type 3 diabetes. He gives a clear picture of how insulin works in our body, how a lack of insulin creates countless health complications and ultimately why it’s becoming more apparent that Alzheimer’s may not simply befall us by chance.

“We all need insulin: in non-diabetics, it’s released to help cells take in the blood sugar (glucose) they need for energy. But the cells can hold only so much; excess sugar is first stored as glycogen, and — when there’s enough of that — as fat. (Blood sugar doesn’t come only from sugar, but from carbohydrates of all kinds; easily digested carbohydrates flood the bloodstream with sugar.)

Insulin not only keeps the blood vessels that supply the brain healthy, it also encourages the brain’s neurons to absorb glucose, and allows those neurons to change and become stronger. Low insulin levels in the brain mean reduced brain function… And when the cells in your brain become insulin-resistant, you start to lose memory and become disoriented. You even might lose aspects of your personality.

In a similar article, writer David DiSalvo specifically explains the negative effects of sugar on the brain and how it can seriously impair your cognitive functions, memory and may cause other diseases.

Research indicates that a diet high in added sugar reduces the production of a brain chemical known as brain-derived neurotrophic factor (BDNF). Without BDNF, our brains can’t form new memories and we can’t learn (or remember) much of anything.

Levels of BDNF are particularly low in people with an impaired glucose metabolism–diabetics and pre-diabetics–and as the amount of BDNF decreases, sugar metabolism worsens… Research has also linked low BDNF levels to depression and dementia. It’s possible that low BDNF may turn out to be the smoking gun in these and other diseases, like Alzheimer’s, that tend to appear in clusters in epidemiological studies.

Since the 2005 study, however, there hasn’t been much change or advancement in preventive treatments based on this idea. While a clinical trial did test the diabetes drug rodiglitazone (Avandia) for the treatment of Alzheimer’s, the results were mixed and without conclusion.

As a different part of her study, she also explains that nitrates, (a preservative found in cheeses, hotdogs, ground beef, smoked meats, and even beer) may also play a part in the equation. Nitrates, when heated, form the amino acid nitrosamine, which impairs how cells interact with insulin, she said. The solution, Dr. DeLaMonte suggests, may not come in the form of a new drug, but instead in making serious lifestyle and diet changes.

For those of us who have  family members or friends with Alzheimer’s, we know how quickly and painfully the disease invades and devastates their brain. What we can learn now from these various discoveries now more than ever, is that it is crucial to abandon the American diet of processed food and sugary substances and instead realize that these seemingly harmless habits are ruining our health and our brain.

 

The Costly Marketing Budget for Antipsychotic Drugs

By Brian L. Grant, MD

At the American Psychological Association Conference, the pharmaceutical industry has a large marketing presence.

The New York Times article, “A Call for Caution in the Use of Antipsychotic Drugs,” was alarming but not surprising to me as a psychiatrist. The numbers are staggering though. The advertising budget alone, at 2.4 billion dollars for the new antipsychotic drugs equates to about $57,000 per US psychiatrist (about 42,000 total)!

This marketing budget total alone just approximates the entire market for non-Federal IME’s and medical reviews. If spread across the U.S. population evenly, each of us would have consumed about 58 dollars worth of antipsychotic drugs in the past year! The use of such medications is clearly concentrated to a small portion of the population and are prescribed in large amounts by a small portion of psychiatrists and other licensed practitioners.

Anyone who has been to a major psychiatric conference would not be surprised at the massive booths from the drug purveyors manned by sharp men and women hawking the wares, with various enticements to visit their booths. The incentives to over-prescribe is clear, given the money involved.

The fact that a number of medical lightweights fail to understand how they are being used as gatekeepers to these drugs is sad and costly, not only for payers, but for patients who are often given these costly drugs with very real side effects, when less costly alternatives with equal or better outcomes exist. To deny the positive impact of these medications in select patients is wrong. But common sense combined with available science should lead to the obvious conclusion that this is not right.

Label creep, where a good drug is advocated for the wrong reasons, is not unique to psychiatry. Articles like this by Dr. Friedman does little to bring pride to my profession. Similar scrutiny is warranted for so-called ADHD (attention deficit hyperactivity disorder) in adults, fibromyalgia and any other malady that is largely associated with profitable, or abused drugs and often direct to consumer advertising to create a wider market.

Looking to Master a Skill? New Study Shows Exercise Can Help

By Vanessa Radatus

It is a well-known fact that regular physical activity not only keeps you healthy, it can also improve brain function and memory.

But in an exciting new study, researchers at the University of Copenhagen have found that exercise can actually help you improve and even master a new skill.

Researchers studied a group of 48 young men and divided them into three groups.  They were all asked to practice a visuomotor tracking activity either before or after a period of intense exercise or without exercise at all. Afterwards, they tested the men from each group after one hour, 24 hours and then a week after the training activity to see if they had improved or retained any of those skills.

The results: Both groups who exercised before or after were able to retain the skills they had learned 24 hours after the computer program. However, compared to those who exercised before the activity, those who exercised immediately after showed better retention of the motor skill even 7 days after. Those who did not exercise at all showed no significant improvement.

So how does exercise help? The findings indicate that just one intense exercise session performed immediately before or after practicing a new skill is enough to improve long-term retention of that motor skill. Researchers suspect that exercise releases brain chemicals during the early stages of memory consolidation that make new muscle memories last for good.

The New York Times provides a detailed explanation in the article “How Exercise Can Help You Master a New Skill,” and shows another reason why exercise is so crucial.  But how can a single workout strengthen a particular skill and store it as a long-term memory in our brain? Dr. Marc Roig, a postdoctoral researcher at the University of Copenhagen suggested it could be biochemistry that makes the memory stronger:

“There is evidence that aerobic exercise produces substances in the brain, like brain-derived neurotropic factor and noradrenaline, that drive memory consolidation and learning… It may be that physical, aerobic exercise performed right after a memory has been formed intensifies the imprinting.” Read more…

Dr Roig also suggests that “timing of the exercise is critical,” For maximum effectiveness,  intense activity needs to be performed “right after exposure to the information to be remembered.”

So next time you are looking to perfect your tennis serve, baseball pitch or piano ensemble, the key could be doing 15 minutes of intense exercise immediately after you’ve practiced.

Is Caffeine Killing Your EQ?

By Vanessa Radatus

For many, coffee is a crucial and much-look-forwarded to part of the day. The strong, distinct aroma of coffee and the feeling of gripping a hot cup on a cool September morning just can’t be beat. It makes you alert, energized and some studies suggest it even improves cognitive task performance-  memory, attention span, etc.

But only in the short-term.

New research from Johns Hopkins Medical School shows that an increase in brain performance after having caffeine is the result of caffeine drinkers experiencing a short-term reversal of caffeine withdrawal.  In essence, coming down from caffeine reduces your emotional intelligence (EQ) and the only way to get back to normal is to drink more.

The article “Caffeine: The Silent Killer of Emotional Intelligence,” in Forbes presents interesting findings on caffeine and it’s effects on the brain. Not only does it lower our performance when we come off our “caffeine high” but it also triggers adrenaline which can cause irritability and anxiety. Researchers at Carnegie Mellon University stated that “large doses of caffeine raise blood pressure, stimulate the heart, and produce rapid shallow breathing, which readers of Emotional Intelligence 2.0 know deprives the brain of the oxygen needed to keep your thinking calm and rational.”

On top of it all, caffeine can create an ongoing cycle of fatigue and low performance.

“Caffeine has a six-hour half-life, which means it takes a full twenty-four hours to work its way out of your system. Have a cup of joe at eight a.m., and you’ll still have 25% of the caffeine in your body at eight p.m. Anything you drink after noon will still be at 50% strength at bedtime. Any caffeine in your bloodstream—with the negative effects increasing with the dose—makes it harder to fall asleep.When you do finally fall asleep, the worst is yet to come. Caffeine disrupts the quality of your sleep by reducing rapid eye movement (REM) sleep, the deep sleep when your body recuperates and processes emotions. When caffeine disrupts your sleep, you wake up the next day with an emotional handicap.” Read More…

So when we wake up feeling exhausted after a normal eight hour sleep cycle, we wonder why but then naturally, grab a cup of joe to start our day. While the article is not necessarily suggesting to stop drinking coffee altogether, it’s explains why it’s important to regulate our caffeine intake because it can negatively affect our mood, brain performance, and sleep cycle.

In an equally interesting article, “What Caffeine Really Does to Your Brain,” the author David DiSalvo talks about his experience after he stopped drinking coffee altogether and the research he found along the way.

“What caffeine does do is one heck of an impersonation. In your brain, caffeine is the quintessential mimic of a neurochemical called adenosine…Your nervous system monitors adenosine levels through receptors, particularly the A1 receptor that is found in your brain and throughout your body. As the chemical passes through the receptors, your adenosine tab increases until your nervous system pays it off by putting you to sleep. The remarkable talent of caffeine is to mimic adenosine’s shape and size, and enter the receptors without activating them. The neurotransmitters dopamine and glutamate, the brain’s own home-grown stimulants, are freer to do their stimulating work with the adenosine tab on hold, and that’s the effect you feel not long after downing your triple shot skinny mochachino.” Read More…

The coffee debate has been going on for years and both sides make solid arguments based on thorough research. Ultimately, it just may be that coffee, like all things, is best enjoyed in moderation.

What Ever Happened to the 7 Poster Children of Oxycontin?

When Oxycontin was introduced to the world, the public was led to believe that it was some kind of addiction-proof miracle drug. In 1998, Purdue Pharma featured a video of seven chronic pain patients who used Oxycontin and could advocate that the drug had helped them regain normal function and enjoyment of everyday life.

The marketing campaign marked the beginning of the industry’s’ hard push for narcotic painkillers and would convince physicians and the public that opioid use was safe, effective, and normal for people with chronic pain. Now, as addictions to painkillers have skyrocketed and fatal overdoses have more than tripled in the past decade, the U.S. has declared prescription drug abuse as a national epidemic.

So what ever happened to these seven poster children of Oxycontin? A very interesting article by the Milwaukee Journal Sentinel, “Where Are They Now?”, explains what happened to the seven patients who spoke glowingly of their experiences with Oxycontin 14 years ago.

In the 1998 video, one patient, Johnny Sullivan, advocated for Oxycontin saying, “Never a drowsy moment here.” Ten years later after severe addiction to Oxycontin and other opioids, he died in a car crash after falling asleep at the wheel.

“Two of the seven patients were active opioid abusers when they died. A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose. Three patients still say the drug helped them cope with their pain and improved their quality of life. A seventh patient declined to answer questions.” Read More…

Purdue’s marketing campaign was so misleading that they plead guilty in 2007 to a federal criminal count of misbranding the drug “with intent to defraud and mislead the public,” paid $635 million in penalties and remains on probation.

Fortune’s article “Oxycontin: Pursue Pharma’s painful medicine”, provides insight into the $3 billion dollar drug and how new legislation has forced the pharmaceutical industry to take action. Read More…

“Oxycontin’s bad reputation, however, has obscured a significant step. Last year Purdue began selling a reformulated version that should help reduce the worst form of abuse. The original drug had a time-release mechanism that could be defeated by crushing the pill and snorting it, smoking it, or adding water to the powder and injecting it for a heroin-like high. (Purdue’s claims that the time-release process reduced the addiction risk were crucial in making doctors feel comfortable prescribing a powerful addictive drug.) By contrast, the new version breaks into chunks rather than a powder; if water is added, the result is a gelatinous goop.”

While some progress is being made to defeat the Prescription drug epidemic, the story of the seven Oxycontin poster children is a sad example of how a powerful marketing campaign and money out-shined the  harmful consequences  of opioid use throughout the country.

9/11 Health Program Will Now Cover 58 Types of Cancer

First reponders searching for victims at Ground Zero after WTC collapse.
Photo by Frank Schwere

In memory of the September 11th terrorist attacks,  first responders, construction workers, volunteers and survivors who helped with rescue and recovery at Ground Zero have reason to be even more hopeful today. The World Trade Center Health Program recently added 58 new types of cancer as a service that would be provided under the James Zadroga 9/11 Health and Compensation Act of 2010.  The act was initially signed by President Obama  in 2010 to provide health coverage to those who lived, worked or attended school in the immediate area of the 9/11 attacks. The Act was named after New York City police detective James Zadroga, who died after working at the site.

The Federal government set aside $4.3 billion dollars for 9/11 victims who had been exposed to airborne toxins and acquired adverse conditions such as asthma, acid reflux disease, back pain and chronic sinus irritation, etc. Though cancer had not originally been drafted in the act, studies have shown that over the course of 11 years the link between the 9/11 toxic dust cloud and cancer may be more evident.

Analysis found that substances in the dust included cement, gypsum, asbestos, glass fibers, calcium carbonate, lead and other metal particles.  Lead and other heavy metals can be toxic to the brain, and gypsum, a component of drywall, can cause respiratory problems if it’s inhaled over a prolonged period of time.

In an interview with ABC World News, Dr. Philip Landrigan, dean of global health at the Mount Sinai School of Medicine in New York explained that those who were in the immediate area during the attacks could have been exposed to an abnormally large amount of these toxins.

“That means it’s extremely caustic and would be like inhaling powdered lye or Drano… Asbestos is a human carcinogen. It causes lung cancer, laryngeal cancers and malignant mesothelioma, and these typically develop anywhere from 10 to 30 years after exposure.”

While it has not yet been proven whether the 9/11 dust cloud was the cause of cancer, the lobbying efforts of construction workers, firefighters, police officers, and others who fell ill a decade after the terror attack  was enough to convince the government to add health coverage for cancer to the list. Read More…

Earphones As Damaging As Jet Engine Noise?

It seems like nearly everyone you encounter, from kids to seniors, is constantly interacting with their cell phone, computer, MP3 player, game console, e-book reader or tablet computer. And while it may be the social norm now, scientists and researchers are watchful to figure out whether our hypeconnectivity could have adverse effects on our health.

A recent study by scientists from the University of Leicester found that listening to high volume on your headphones can damage the coating of nerve cells in your ears, causing temporary deafness. While it depends on the type of headphones you use,  how loud and how often you use them, you could be subjecting your ears to noise levels similar to that of a jet engine.

The study showed that exposure to loud noises 110 decibels and higher can strip the cells of a coating within our ear called the myelin sheath, which helps the electrical signals travel along the cell. The excessive noise disrupts the electrical signals which means the nerves can’t efficiently transmit information from the ears to the brain. So if you’ve ever turned your iPod up near maximum volume for extended periods of time , you’ve likely been listening to your music at 110 decibels, the same noise level as a jet engine.

Sound is measured in decibels and it may surprise you how some of your daily activities may be noisier than you think. Here are some decibel levels of common sounds:

  • Firecracker: 150 dB
  • Ambulance siren or airplane taking off: 120 dB
  • Nightclub: 120 dB
  • Jet engine: 120+dB
  • Movie theatre: up to 117 dB
  • Rock concert: 110-125 dB
  • Listening to music with headphones: 105-120 dB if the volume is cranked up to the maximum setting (earbuds, which you insert directly into your ear, can add 6-9 dB to the volume)
  • Motorcycle: 95 dB
  • Noisy restaurant or heavy traffic in the city: 85 dB
  • Normal conversation: 60 dB
  • Fridge humming: 40 dB
  • Whispering: 30-15 dB

Believe it or not, being exposed to anything louder than 85 dB for extended period of time can cause permanent hearing loss and it’s often irreversible. Also, an occasional loud noise may cause you less loss then extended exposure of a much quieter sound. For example, 8 hours at 85 dB causes as much damage as 4 hours at 88 dB, 2 hours at 91 dB, or just 15 minutes at 100 dB.

However, the study also showed for the first time that the coating surrounding the nerve cells can reform, letting the cells function again as normal. This means hearing loss can be temporary, and full hearing can return, the researchers said. In an article by Science Daily, Dr Hamann explained:

“We now understand why hearing loss can be reversible in certain cases. We showed that the sheath around the auditory nerve is lost in about half of the cells we looked at, a bit like stripping the electrical cable linking an amplifier to the loudspeaker. The effect is reversible and after three months, hearing has recovered and so has the sheath around the auditory nerve…The work will help prevention as well as progression into finding appropriate cures for hearing loss.” Read More…

The new research could lead to the first drug treatments to prevent the development of tinnitus (ringing in the ears)and/or cures to hearing loss but it is still an ongoing project. Regardless, we should always protect our ears, limit our headphone use and keep the volume below sixty percent.

FDA Cracks Down on Precription Opioid Abuse

Last  month, the U.S. Food and Drug Administration (FDA) approved an initiative that aims to prevent future abuse of extended release and long-acting opioids. The program, known as a Risk Evaluation and Mitigation Strategy (REMS), primarily requires opioid manufactures to educate doctors about proper pain management, patient selection, and how to ensure that the benefits of the drug outweigh the risks.

Drugs like Oxycontin, Avinza, Dolophine, Duragesic, and eight other brand names are among the most commonly abused prescription drugs and tend to lead to overdoses, addiction, and thousands of deaths across the U.S.

The FDA estimates that 23 million people were prescribed ER/LA opioid drugs in 2011 and many are at high risk of abusing them because many people are not aware of the risks. FDA commissioner, Dr. Margaret Hamburg says, “The FDA’s goal with this risk evaluation and mitigation strategy approval is to ensure that health care professionals are educated on how to safely prescribe opioids and that patients know how to safely use these drugs.”

The FDA and the Obama administration aim to shed light on issues of misprescribing and overprescribing while improving awareness about the dangers of opioid drugs. Since July 9, 2012, the FDA is now notifying opioid makers that they must propose a REMS plan within 120 days. In hopes of tackling the prescription drug epidemic, the FDA wants the plan to include a way to keep track of whether the numbers of misuse, addiction, and mis-prescribed are coming down. Read more…

Gil Kerlikowske, director of the Office of National Drug Control Policy, said:

“We commend the FDA for taking action to save lives by increasing access to prescriber education. Since day one, the Obama Administration has been laser focused on addressing the prescription drug abuse epidemic and today’s action is an important contribution to this comprehensive effort.”