Pain Relief Through Photography
Can looking at the photograph of a loved one make pain go away?
Numerous studies show that strong social connections have benefits for health. People who have active social lives seem to live longer than those who are isolated, and married cancer patients have a better outlook than divorced cancer patients. Now, a study [pdf] suggests that merely looking at a photograph of a loved one can relieve the sensation of physical pain.
Psychologists at the University of California, Los Angeles, recruited 25 women who had steady boyfriends. Using a tool that applied heat to the women’s forearms, they turned up the temperature until it was slightly uncomfortable and asked the women to rate the pain they experienced on a scale of one to 20.
The researchers manipulated the heat and recorded the women’s reactions under different conditions: while she was looking at a photo of her boyfriend, or a photo of a complete stranger and a chair. They also had the women rate the pain while they held the hand of a stranger hidden behind a curtain, and as they held their boyfriend’s hand or a squeeze ball.
“We saw lower pain ratings on average when the women were holding their partner’s hand compared with a stranger’s hand or an object,” said Sarah L. Master, the lead author of the paper, who did the study at U.C.L.A. as part of her doctoral research.
When the women looked at photographs of their boyfriends, they rated the pain lower than when they were staring at a photo of a stranger or a chair. Surprisingly, they even ranked the pain lower than they had while holding their boyfriend’s hand.
“It’s interesting that a physical sensation can actually become more manageable by just looking at a photo of someone you find supportive,” Dr. Master said. The study appeared in the November issue of the journal Psychological Science.
Under certain circumstances, Dr. Master suggested, looking at a photo may have an even stronger effect than having the person physically present. “Having the actual person there might not be a good thing if the person is in a bad mood or not being supportive at that moment. A picture could be a better solution,” she said.
Dr. Master said the mere reminder of the loved one may engender feelings of support, possibly by prompting the release of endogenous opioids, chemicals in the brain that have pain relief effects.
Showing posts with label Health. Show all posts
Showing posts with label Health. Show all posts
Monday, January 23, 2012
Really? The Claim: Yoga Can Help Manage Pain
Really? The Claim: Yoga Can Help Manage Pain
THE FACTS
For many people, yoga is more than just exercise: Studies show it is one of the most commonly used forms of alternative therapy in the country. Many rely on yoga to relieve chronic and acute pain.
The reasons for this are varied. Some researchers believe that yoga may alleviate pain through relaxation and the release of endorphins. Others say it may reduce inflammation and promote positive emotions.
Plenty of studies have tried to determine whether taking up yoga can actually help lessen pain. In a recent report, a team of researchers sifted through the science and identified 10 randomized clinical trials on the subject involving hundreds of patients.
The studies looked at yoga’s effect on pain stemming from ailments like arthritis, low back problems, pregnancy symptoms and migraines. The control conditions were standard treatments and exercise, diet and lifestyle changes.
Nine out of the 10 clinical trials found yoga could help provide relief from pain, which the authors called “encouraging.” But they also noted that no definitive conclusion could be reached, for a number of reasons.
The studies involved patients experiencing pain from a wide variety of conditions, and they looked at several types of yoga that had some similarities, like breathing, stretching and relaxation exercises — but also many differences. Complicating matters was that the intensity, amount of time and frequency of the yoga sessions differed from one study to the next.
While the evidence suggests that yoga has the potential to alleviate pain, they wrote, the science is not firm enough to say for certain.
THE FACTS
For many people, yoga is more than just exercise: Studies show it is one of the most commonly used forms of alternative therapy in the country. Many rely on yoga to relieve chronic and acute pain.
The reasons for this are varied. Some researchers believe that yoga may alleviate pain through relaxation and the release of endorphins. Others say it may reduce inflammation and promote positive emotions.
Plenty of studies have tried to determine whether taking up yoga can actually help lessen pain. In a recent report, a team of researchers sifted through the science and identified 10 randomized clinical trials on the subject involving hundreds of patients.
The studies looked at yoga’s effect on pain stemming from ailments like arthritis, low back problems, pregnancy symptoms and migraines. The control conditions were standard treatments and exercise, diet and lifestyle changes.
Nine out of the 10 clinical trials found yoga could help provide relief from pain, which the authors called “encouraging.” But they also noted that no definitive conclusion could be reached, for a number of reasons.
The studies involved patients experiencing pain from a wide variety of conditions, and they looked at several types of yoga that had some similarities, like breathing, stretching and relaxation exercises — but also many differences. Complicating matters was that the intensity, amount of time and frequency of the yoga sessions differed from one study to the next.
While the evidence suggests that yoga has the potential to alleviate pain, they wrote, the science is not firm enough to say for certain.
Giving Chronic Pain a Medical Platform of Its Own
Giving Chronic Pain a Medical Platform of Its Own
Most doctors view pain as a symptom of an underlying problem — treat the disease or the injury, and the pain goes away.
But for large numbers of patients, the pain never goes away. In a sweeping review issued last month, the Institute of Medicine — the medical branch of the National Academy of Sciences — estimated that chronic pain afflicts 116 million Americans, far more than previously believed.
The toll documented in the report is staggering. Childbirth, for example, is a common source of chronic pain: The institute found that 18 percent of women who have Caesarean deliveries and 10 percent who have vaginal deliveries report still being in pain a year later.
Ten percent to 50 percent of surgical patients who have pain after surgery go on to develop chronic pain, depending on the procedure, and for as many as 10 percent of those patients, the chronic postoperative pain is severe. (About 1 in 4 Americans suffer from frequent lower back pain.)
The risk of suicide is high among chronic pain patients. Two studies found that about 5 percent of those with musculoskeletal pain had tried to kill themselves; among patients with chronic abdominal pain, the number was 14 percent.
“Before, we didn’t have good data on what is the burden of pain in our society,” said Dr. Sean Mackey, chief of pain management at the Stanford School of Medicine and a member of the committee that produced the report. “The number of people is more than diabetes, heart disease and cancer combined.”
For patients, acknowledgment of the problem from the prestigious Institute of Medicine is a seminal event. Chronic pain often goes untreated because most doctors haven’t been trained to understand it. And it is isolating: Family members and friends may lose patience with the constant complaints of pain sufferers. Doctors tend to throw up their hands, referring patients for psychotherapy or dismissing them as drug seekers trying to get opioids.
“Most people with chronic pain are still being treated as if pain is a symptom of an underlying problem,” said Melanie Thernstrom, a chronic pain sufferer from Vancouver, Wash., who wrote “The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering” (Farrar, Straus & Giroux, 2010) and was a patient representative on the committee.
“If the doctor can’t figure out what the underlying problem is,” she went on, “then the pain is not treated, it’s dismissed and the patient falls down the rabbit hole.”
Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.
“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,” Dr. Mackey said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.”
The institute emphasized the importance of prevention and early treatment, a novel concept for many doctors who try to diagnose the source of pain before treating it or advise patients to wait it out in the hope it will go away on its own.
“Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”
Ms. Thernstrom compared the effect of chronic pain on the body to the rushing waters of a river carving out a new tributary. Pain, she says, also changes the body’s landscape.
“My pain is at the level where it’s manageable,” she said. “I do wish I had gotten aggressive treatment in the first year. There is a window of time to intervene, because pain changes your nervous system and pain pathways develop.”
The report also acknowledged the “conundrum of opioids,” noting that doctors are conflicted about how to treat pain because of worries about drug addiction. But the group noted that proper use of the drugs early in a pain cycle can resolve pain problems sooner, and stated that opioids are also particularly useful for pain management near the end of life.
The pain report is only a first step for the community of medical professionals who treat pain. It will be up to medical schools to begin better education of doctors in the treatment of pain, and the National Institutes of Health to decide whether to promote research into chronic pain. Patients, too, need to be educated about the importance of early treatment of pain rather than gutting it out or waiting until it has become severe and chronic.
“Some people were expecting a cure within the report,” Dr. Mackey said. “There’s no immediate cure. But I’ve seen a lot of patients who have said, ‘Finally they are putting out a report that helps others understand what I’m going through.’ ”
Most doctors view pain as a symptom of an underlying problem — treat the disease or the injury, and the pain goes away.
But for large numbers of patients, the pain never goes away. In a sweeping review issued last month, the Institute of Medicine — the medical branch of the National Academy of Sciences — estimated that chronic pain afflicts 116 million Americans, far more than previously believed.
The toll documented in the report is staggering. Childbirth, for example, is a common source of chronic pain: The institute found that 18 percent of women who have Caesarean deliveries and 10 percent who have vaginal deliveries report still being in pain a year later.
Ten percent to 50 percent of surgical patients who have pain after surgery go on to develop chronic pain, depending on the procedure, and for as many as 10 percent of those patients, the chronic postoperative pain is severe. (About 1 in 4 Americans suffer from frequent lower back pain.)
The risk of suicide is high among chronic pain patients. Two studies found that about 5 percent of those with musculoskeletal pain had tried to kill themselves; among patients with chronic abdominal pain, the number was 14 percent.
“Before, we didn’t have good data on what is the burden of pain in our society,” said Dr. Sean Mackey, chief of pain management at the Stanford School of Medicine and a member of the committee that produced the report. “The number of people is more than diabetes, heart disease and cancer combined.”
For patients, acknowledgment of the problem from the prestigious Institute of Medicine is a seminal event. Chronic pain often goes untreated because most doctors haven’t been trained to understand it. And it is isolating: Family members and friends may lose patience with the constant complaints of pain sufferers. Doctors tend to throw up their hands, referring patients for psychotherapy or dismissing them as drug seekers trying to get opioids.
“Most people with chronic pain are still being treated as if pain is a symptom of an underlying problem,” said Melanie Thernstrom, a chronic pain sufferer from Vancouver, Wash., who wrote “The Pain Chronicles: Cures, Myths, Mysteries, Prayers, Diaries, Brain Scans, Healing and the Science of Suffering” (Farrar, Straus & Giroux, 2010) and was a patient representative on the committee.
“If the doctor can’t figure out what the underlying problem is,” she went on, “then the pain is not treated, it’s dismissed and the patient falls down the rabbit hole.”
Among the important findings in the Institute of Medicine report is that chronic pain often outlasts the original illness or injury, causing changes in the nervous system that worsen over time. Doctors often cannot find an underlying cause because there isn’t one. Chronic pain becomes its own disease.
“When pain becomes chronic, when it becomes persistent even after the tissue and injury have healed, then people are suffering from chronic pain,” Dr. Mackey said. “We’re finding that there are significant changes in the central nervous system and spinal cord that cause pain to become amplified and persistent even after the injury has gone away.”
The institute emphasized the importance of prevention and early treatment, a novel concept for many doctors who try to diagnose the source of pain before treating it or advise patients to wait it out in the hope it will go away on its own.
“Having pain that is not treated is like having diabetes that’s not treated,” said Ms. Thernstrom, who suffers from spinal stenosis and a form of arthritis in the neck. “It gets worse over time.”
Ms. Thernstrom compared the effect of chronic pain on the body to the rushing waters of a river carving out a new tributary. Pain, she says, also changes the body’s landscape.
“My pain is at the level where it’s manageable,” she said. “I do wish I had gotten aggressive treatment in the first year. There is a window of time to intervene, because pain changes your nervous system and pain pathways develop.”
The report also acknowledged the “conundrum of opioids,” noting that doctors are conflicted about how to treat pain because of worries about drug addiction. But the group noted that proper use of the drugs early in a pain cycle can resolve pain problems sooner, and stated that opioids are also particularly useful for pain management near the end of life.
The pain report is only a first step for the community of medical professionals who treat pain. It will be up to medical schools to begin better education of doctors in the treatment of pain, and the National Institutes of Health to decide whether to promote research into chronic pain. Patients, too, need to be educated about the importance of early treatment of pain rather than gutting it out or waiting until it has become severe and chronic.
“Some people were expecting a cure within the report,” Dr. Mackey said. “There’s no immediate cure. But I’ve seen a lot of patients who have said, ‘Finally they are putting out a report that helps others understand what I’m going through.’ ”
In Rating Pain, Women Are the More Sensitive Sex
In Rating Pain, Women Are the More Sensitive Sex
Do women feel more pain than men?
It has long been known that certain pain-related conditions, like fibromyalgia, migraine and irritable bowel syndrome, are more common in women than in men. And chronic pain after childbirth is surprisingly common; the Institute of Medicine recently found that 18 percent of women who have Caesarean deliveries and 10 percent who have vaginal deliveries report still being in pain a year later.
But new research from Stanford University suggests that even when men and women have the same condition — whether it’s a back problem, arthritis or a sinus infection — women appear to suffer more from the pain.
There is an epidemic of chronic pain: Last year, the Institute of Medicine estimated that it afflicts 116 million Americans, far more than previously believed. But these latest findings, believed to be the largest study ever to compare pain levels in men and women, raise new questions about whether women are shouldering a disproportionate burden of chronic pain and suggest a need for more gender-specific pain research.
The study, published Monday in The Journal of Pain, analyzes data from the electronic medical records of 11,000 patients whose pain scores were recorded as a routine part of their care. (To obtain pain scores, doctors ask patients to describe their pain on a scale from 0, for no pain, to 10, “worst pain imaginable.”)
For 21 of 22 ailments with sample sizes large enough to make a meaningful comparison, the researchers found that women reported higher levels of pain than men. For back pain, women reported a score of 6.03, men 5.53. For joint and inflammatory pain, it was women 6.00, men 4.93. Women reported significantly higher pain levels with diabetes, hypertension, ankle injuries and even sinus infections.
For several diagnoses, women’s average pain score was at least one point higher than men’s, which is considered a clinically meaningful difference. Over all, their pain levels were about 20 percent higher than men’s.
Unfortunately, the data don’t offer any clues as to why women report higher pain levels. One possibility is that men have been socialized to be more stoic, so they underreport pain. But the study’s senior author, Dr. Atul Butte, an associate professor at Stanford’s medical school, said that explanation probably did not account for the gender gap.
“While you can imagine such a bias,” he said, “across studies, across thousands of patients, it’s hard to believe men are like this. You have to think about biological causes for the difference.”
An extensive 2007 report by the International Association for the Study of Pain cited studies showing that sex hormones may play a role in pain response. In fact, some of the gender differences, particularly regarding headache and abdominal pain, begin to diminish after women reach menopause.
Research also suggests that men and women have different responses to anesthesia and pain drugs, reporting different levels of efficacy and side effects. That bolsters the idea that men and women experience pain differently.
One reason for the lack of information about sex differences is that many pain studies, in both animals and humans, are done only in males. One analysis found that 79 percent of the animal studies published in a pain journal over a decade included only male subjects, compared with 8 percent that used only female animals.
In addition, experiments testing pain in men and women have shown that they typically have different thresholds for various types of pain. In general, women report higher levels of pain from pressure and electrical stimulation, and less pain when the source is from heat.
Melanie Thernstrom, a patient representative on the Institute of Medicine pain committee from Vancouver, Wash., said the newest research “really highlights the need for more treatment and better treatment that is gender-specific, and the need for far more research to really understand why women’s brains process pain differently than men.”
Some researchers believe the pain experience for women may be even more complicated. Women who have given birth, for instance, may have a different threshold for “worst pain ever,” causing them to underreport certain types of pain. The bottom line, Dr. Butte said, is that far too little is known about how men and women experience pain and that more study is needed so that, ultimately, pain treatment can be customized to each patient’s needs.
“If doctors have a threshold for when they give a dose or start a medication,” he said, “you could imagine that the number they are using is too high or too low because a person may be in more pain than they are saying.
“In the end, it comes down to what the brain perceives as pain.”
Do women feel more pain than men?
It has long been known that certain pain-related conditions, like fibromyalgia, migraine and irritable bowel syndrome, are more common in women than in men. And chronic pain after childbirth is surprisingly common; the Institute of Medicine recently found that 18 percent of women who have Caesarean deliveries and 10 percent who have vaginal deliveries report still being in pain a year later.
But new research from Stanford University suggests that even when men and women have the same condition — whether it’s a back problem, arthritis or a sinus infection — women appear to suffer more from the pain.
There is an epidemic of chronic pain: Last year, the Institute of Medicine estimated that it afflicts 116 million Americans, far more than previously believed. But these latest findings, believed to be the largest study ever to compare pain levels in men and women, raise new questions about whether women are shouldering a disproportionate burden of chronic pain and suggest a need for more gender-specific pain research.
The study, published Monday in The Journal of Pain, analyzes data from the electronic medical records of 11,000 patients whose pain scores were recorded as a routine part of their care. (To obtain pain scores, doctors ask patients to describe their pain on a scale from 0, for no pain, to 10, “worst pain imaginable.”)
For 21 of 22 ailments with sample sizes large enough to make a meaningful comparison, the researchers found that women reported higher levels of pain than men. For back pain, women reported a score of 6.03, men 5.53. For joint and inflammatory pain, it was women 6.00, men 4.93. Women reported significantly higher pain levels with diabetes, hypertension, ankle injuries and even sinus infections.
For several diagnoses, women’s average pain score was at least one point higher than men’s, which is considered a clinically meaningful difference. Over all, their pain levels were about 20 percent higher than men’s.
Unfortunately, the data don’t offer any clues as to why women report higher pain levels. One possibility is that men have been socialized to be more stoic, so they underreport pain. But the study’s senior author, Dr. Atul Butte, an associate professor at Stanford’s medical school, said that explanation probably did not account for the gender gap.
“While you can imagine such a bias,” he said, “across studies, across thousands of patients, it’s hard to believe men are like this. You have to think about biological causes for the difference.”
An extensive 2007 report by the International Association for the Study of Pain cited studies showing that sex hormones may play a role in pain response. In fact, some of the gender differences, particularly regarding headache and abdominal pain, begin to diminish after women reach menopause.
Research also suggests that men and women have different responses to anesthesia and pain drugs, reporting different levels of efficacy and side effects. That bolsters the idea that men and women experience pain differently.
One reason for the lack of information about sex differences is that many pain studies, in both animals and humans, are done only in males. One analysis found that 79 percent of the animal studies published in a pain journal over a decade included only male subjects, compared with 8 percent that used only female animals.
In addition, experiments testing pain in men and women have shown that they typically have different thresholds for various types of pain. In general, women report higher levels of pain from pressure and electrical stimulation, and less pain when the source is from heat.
Melanie Thernstrom, a patient representative on the Institute of Medicine pain committee from Vancouver, Wash., said the newest research “really highlights the need for more treatment and better treatment that is gender-specific, and the need for far more research to really understand why women’s brains process pain differently than men.”
Some researchers believe the pain experience for women may be even more complicated. Women who have given birth, for instance, may have a different threshold for “worst pain ever,” causing them to underreport certain types of pain. The bottom line, Dr. Butte said, is that far too little is known about how men and women experience pain and that more study is needed so that, ultimately, pain treatment can be customized to each patient’s needs.
“If doctors have a threshold for when they give a dose or start a medication,” he said, “you could imagine that the number they are using is too high or too low because a person may be in more pain than they are saying.
“In the end, it comes down to what the brain perceives as pain.”
Wednesday, January 18, 2012
Osteoporosis Patients Advised to Delay Bone Density Retests
Osteoporosis Patients Advised to Delay Bone Density Retests
Bone loss and osteoporosis develop so slowly in most women whose bones test normal at age 65 that many can safely wait as long as 15 years before having a second bone density test, researchers report in a new study.
The study, published in Thursday’s issue of The New England Journal of Medicine, is part of a broad rethinking of how to diagnose and treat the potentially debilitating bone disease that can lead to broken hips and collapsing spines.
A class of drugs, bisphosphonates, which includes Fosamax, have been found to prevent fractures in people with osteoporosis. But medical experts no longer recommend the medicines to prevent osteoporosis itself. They no longer want women to take them indefinitely, and no longer consider bone density measurements the sole defining factor in deciding if a woman needs to be treated.
Now, with the new study, researchers are asking whether frequent bone density measurements even make sense for the majority of older women whose bone density is not near a danger zone on initial tests, recommended at age 65.
“Bone density testing has been oversold,” said Steven Cummings, the study’s principal investigator and an emeritus professor of medical epidemiology and biostatistics at the University of California, San Francisco.
The study followed nearly 5,000 women ages 67 and older for more than a decade. The women had a bone density test when they entered the study and did not have osteoporosis. (In a separate national study by the Centers for Disease Control and Prevention, about 70 percent of women over age 65 did not have osteoporosis.)
The researchers report that fewer than 1 percent of women with normal bone density when they entered the study, and fewer than 5 percent with mildly low bone density, developed osteoporosis in the ensuing 15 years. But of those with substantially low bone density at the study’s start, close to the cutoff point for osteoporosis of fewer than 2.5 standard deviations from the reference level, 10 percent progressed to osteoporosis in about a year.
Dr. Margaret Gourlay, the study’s lead author and a family practice specialist and osteoporosis researcher at the University of North Carolina, said she and her colleagues were surprised by how slowly osteoporosis progressed in women.
Medicare pays for a bone density test every two years and many doctors have assumed that is the ideal interval, although national guidelines recommend them only at “regular intervals.”
“I think this will change the way doctors think about screening,” Dr. Gourlay said.
The results, said Joan A. McGowan, director of the division of musculoskeletal diseases at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, “provide telling evidence that you are not going to fall off a cliff if you have normal bone density in your 60s or early 70s, that you are not going to have osteoporosis in the next five years unless something else happens.”
For example, said Dr. McGowan, who was not involved in the study, a woman who had to take high doses of corticosteroids for another medical condition would lose bone rapidly. But the findings “cover most normal women,” she said.
Bone density screening took off after Fosamax, the first bisphosphonate, was approved at the end of 1995. For the first time, doctors had a specific treatment that had been shown to prevent fractures in people with osteoporosis.
For years doctors were overly enthusiastic, prescribing it for women whose bone density was lower than normal but not in a danger zone, keeping women on the drug indefinitely. They even gave a name, osteopenia, to lower than normal bone density, although it was not clear it had real clinical significance.
Now, osteoporosis experts consider osteopenia to be a risk factor, not a disease, and its importance varies depending on a patient’s age, said Dr. Ethel S. Siris, an osteoporosis researcher at Columbia University who was not involved in the study.
Doctors are more likely to prescribe bisphosphonates for older patients and recommend against them for most younger postmenopausal women with osteopenia.
The experts also generally recommend that most people on bisphosphonates take them for just five years at a time, followed by a drug holiday of undetermined length. The idea is to reduce the risk of rare but serious side effects, including unusual thighbone fractures and loss of bone in the jaw.
A risk calculator, FRAX, can help determine whether treatment is recommended. It assesses a combination of risk factors: whether a parent has had a hip fracture, the age of the patient, steroid use, bone density at the hip, and whether the person has broken a bone after age 50, an especially important indicator. Nearly half who break a hip already had already broken another bone, Dr. Siris said.
“If you are an older individual, a man or a woman, who already broke a major bone — spine, hip, shoulder, or pelvis or wrist — take it very seriously and get treated,” she said. “If you have relatively good bone density then you are not at risk now.”
Bone loss and osteoporosis develop so slowly in most women whose bones test normal at age 65 that many can safely wait as long as 15 years before having a second bone density test, researchers report in a new study.
The study, published in Thursday’s issue of The New England Journal of Medicine, is part of a broad rethinking of how to diagnose and treat the potentially debilitating bone disease that can lead to broken hips and collapsing spines.
A class of drugs, bisphosphonates, which includes Fosamax, have been found to prevent fractures in people with osteoporosis. But medical experts no longer recommend the medicines to prevent osteoporosis itself. They no longer want women to take them indefinitely, and no longer consider bone density measurements the sole defining factor in deciding if a woman needs to be treated.
Now, with the new study, researchers are asking whether frequent bone density measurements even make sense for the majority of older women whose bone density is not near a danger zone on initial tests, recommended at age 65.
“Bone density testing has been oversold,” said Steven Cummings, the study’s principal investigator and an emeritus professor of medical epidemiology and biostatistics at the University of California, San Francisco.
The study followed nearly 5,000 women ages 67 and older for more than a decade. The women had a bone density test when they entered the study and did not have osteoporosis. (In a separate national study by the Centers for Disease Control and Prevention, about 70 percent of women over age 65 did not have osteoporosis.)
The researchers report that fewer than 1 percent of women with normal bone density when they entered the study, and fewer than 5 percent with mildly low bone density, developed osteoporosis in the ensuing 15 years. But of those with substantially low bone density at the study’s start, close to the cutoff point for osteoporosis of fewer than 2.5 standard deviations from the reference level, 10 percent progressed to osteoporosis in about a year.
Dr. Margaret Gourlay, the study’s lead author and a family practice specialist and osteoporosis researcher at the University of North Carolina, said she and her colleagues were surprised by how slowly osteoporosis progressed in women.
Medicare pays for a bone density test every two years and many doctors have assumed that is the ideal interval, although national guidelines recommend them only at “regular intervals.”
“I think this will change the way doctors think about screening,” Dr. Gourlay said.
The results, said Joan A. McGowan, director of the division of musculoskeletal diseases at the National Institute of Arthritis and Musculoskeletal and Skin Diseases, “provide telling evidence that you are not going to fall off a cliff if you have normal bone density in your 60s or early 70s, that you are not going to have osteoporosis in the next five years unless something else happens.”
For example, said Dr. McGowan, who was not involved in the study, a woman who had to take high doses of corticosteroids for another medical condition would lose bone rapidly. But the findings “cover most normal women,” she said.
Bone density screening took off after Fosamax, the first bisphosphonate, was approved at the end of 1995. For the first time, doctors had a specific treatment that had been shown to prevent fractures in people with osteoporosis.
For years doctors were overly enthusiastic, prescribing it for women whose bone density was lower than normal but not in a danger zone, keeping women on the drug indefinitely. They even gave a name, osteopenia, to lower than normal bone density, although it was not clear it had real clinical significance.
Now, osteoporosis experts consider osteopenia to be a risk factor, not a disease, and its importance varies depending on a patient’s age, said Dr. Ethel S. Siris, an osteoporosis researcher at Columbia University who was not involved in the study.
Doctors are more likely to prescribe bisphosphonates for older patients and recommend against them for most younger postmenopausal women with osteopenia.
The experts also generally recommend that most people on bisphosphonates take them for just five years at a time, followed by a drug holiday of undetermined length. The idea is to reduce the risk of rare but serious side effects, including unusual thighbone fractures and loss of bone in the jaw.
A risk calculator, FRAX, can help determine whether treatment is recommended. It assesses a combination of risk factors: whether a parent has had a hip fracture, the age of the patient, steroid use, bone density at the hip, and whether the person has broken a bone after age 50, an especially important indicator. Nearly half who break a hip already had already broken another bone, Dr. Siris said.
“If you are an older individual, a man or a woman, who already broke a major bone — spine, hip, shoulder, or pelvis or wrist — take it very seriously and get treated,” she said. “If you have relatively good bone density then you are not at risk now.”
Tuesday, January 17, 2012
Obesity Rates Stall, But No Decline
Obesity Rates Stall, But No Decline
After two decades of steady increases, obesity rates in adults and children in the United States have remained largely unchanged during the past 12 years, a finding that suggests national efforts at promoting healthful eating and exercise are having little effect on the overweight.
Over all, 35.7 percent of the adult population and 16.9 percent of children qualify as obese, according to data gathered by the federal Centers for Disease Control and Prevention and published online Tuesday by The Journal of the American Medical Association. While it is good news that the ranks of the obese in America are not growing, the data also point to the intractable nature of weight gain and signal that the country will be dealing with the health consequences of obesity for years to come.
“We’re by no means through the epidemic,’’ said Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston. “Children will be entering adulthood heavier than they’ve ever been at any time in human history. Even without further increases in prevalence, the impact of the epidemic will continue to mount for many years to come.’’
The data come from thousands of men, women and children who have taken part in the National Health and Nutrition Examination Surveys — compiled by the National Center for Health Statistics at the C.D.C. since the 1960s — and represent some of the most reliable statistics available on the health of the American public. The most recent findings are based on data collected from 2009-10 that have been compared with previous surveys collected in two-year cycles beginning in 1999-2000.
Although from a statistical standpoint, overall obesity rates haven’t changed in more than a decade, the latest analysis did detect some changes in the prevalence of obesity in certain groups. For instance, men and boys have become fatter since 1999, and so have non-Hispanic black and Mexican-American women. Although those trends were only recently detected in the data, there have been no significant increases in obesity prevalence since the 2003-4 survey.
Nobody knows exactly why obesity rates appear to be leveling off. While it’s possible that public education efforts around healthful eating and exercise have had some effect, it may be that the population has reached a biological saturation point in terms of obesity, and that those most vulnerable have already become obese.
“Until we actually see declines in body mass index we can’t confidently say prevention efforts have succeeded,” said Dr. Ludwig.
Although different data collection methods make it difficult to compare obesity rates around the world, a number of studies in other countries have suggested that the prevalence of obesity is growing more slowly or has hit a plateau. Data from England show that for men the prevalence of obesity was 22.2 percent in 2005 and 22.1 percent in 2009; comparable figures for women were 23 percent and 23.9 percent. Studies in Sweden, Switzerland and Spain have also suggested a leveling off of obesity rates.
After two decades of steady increases, obesity rates in adults and children in the United States have remained largely unchanged during the past 12 years, a finding that suggests national efforts at promoting healthful eating and exercise are having little effect on the overweight.
Over all, 35.7 percent of the adult population and 16.9 percent of children qualify as obese, according to data gathered by the federal Centers for Disease Control and Prevention and published online Tuesday by The Journal of the American Medical Association. While it is good news that the ranks of the obese in America are not growing, the data also point to the intractable nature of weight gain and signal that the country will be dealing with the health consequences of obesity for years to come.
“We’re by no means through the epidemic,’’ said Dr. David Ludwig, director of the childhood obesity program at Children’s Hospital in Boston. “Children will be entering adulthood heavier than they’ve ever been at any time in human history. Even without further increases in prevalence, the impact of the epidemic will continue to mount for many years to come.’’
The data come from thousands of men, women and children who have taken part in the National Health and Nutrition Examination Surveys — compiled by the National Center for Health Statistics at the C.D.C. since the 1960s — and represent some of the most reliable statistics available on the health of the American public. The most recent findings are based on data collected from 2009-10 that have been compared with previous surveys collected in two-year cycles beginning in 1999-2000.
Although from a statistical standpoint, overall obesity rates haven’t changed in more than a decade, the latest analysis did detect some changes in the prevalence of obesity in certain groups. For instance, men and boys have become fatter since 1999, and so have non-Hispanic black and Mexican-American women. Although those trends were only recently detected in the data, there have been no significant increases in obesity prevalence since the 2003-4 survey.
Nobody knows exactly why obesity rates appear to be leveling off. While it’s possible that public education efforts around healthful eating and exercise have had some effect, it may be that the population has reached a biological saturation point in terms of obesity, and that those most vulnerable have already become obese.
“Until we actually see declines in body mass index we can’t confidently say prevention efforts have succeeded,” said Dr. Ludwig.
Although different data collection methods make it difficult to compare obesity rates around the world, a number of studies in other countries have suggested that the prevalence of obesity is growing more slowly or has hit a plateau. Data from England show that for men the prevalence of obesity was 22.2 percent in 2005 and 22.1 percent in 2009; comparable figures for women were 23 percent and 23.9 percent. Studies in Sweden, Switzerland and Spain have also suggested a leveling off of obesity rates.
Monday, January 16, 2012
Noodle and Apple Kugel
Noodle and Apple Kugel
This comforting kugel tastes much richer than it is, and it is certainly lighter than a traditional kugel (though it is not a low-calorie dessert). I’ve made this with Golden Delicious apples and with tarter varieties like Pink Lady; I liked it both ways.
2 tablespoons unsalted butter
4 apples, cored and cut in small (1/4- to 1/2-inch) dice
6 ounces flat egg noodles, preferably whole-grain
Salt to taste
1/4 cup raisins, plumped for 5 minutes in warm water and drained (optional)
4 eggs
1/4 cup raw brown sugar or dark brown sugar
1 cup drained yogurt
1 teaspoon vanilla extract
2 tablespoons rum
1/2 teaspoon freshly grated nutmeg
1. Preheat the oven to 350 degrees. Butter a 2-quart baking dish. Begin heating a large pot of water.
2. Melt 1 tablespoon of the butter over medium-high heat in a large, heavy skillet and add the apples. Cook, stirring or tossing in the pan, until they begin to color and are slightly tender, about 5 minutes. Remove from the heat.
3. When the water comes to a boil, add salt to taste and the noodles. Cook al dente, a little firmer than you would want them if you were eating them right away. Drain through a colander and add to the pan with the apples (if using long flat noodles, cut them first with a scissors into shorter lengths). Add the remaining tablespoon of butter and toss together until the butter melts. Stir in the optional raisins. Set aside.
4. Beat the eggs in a large bowl. Add the sugar and beat together until the mixture is thick. Beat in the yogurt, vanilla, rum, nutmeg and about 1/4 teaspoon salt, or to taste. Add the noodles and apples and fold everything together. Scrape into the prepared baking dish. Push the pasta down into the egg and yogurt mixture (it will not be completely submerged, but try to cover as much as you can). Place in the oven and bake 40 to 45 minutes, until the kugel is set and the sides are browned. There will always be some noodles on top that brown and become quite hard. You can remove these from the baked dish if you wish. Allow to sit for at least 10 minutes before serving. Serve hot, warm or at room temperature.
Yield: 6 servings.
Advance preparation: I love this for breakfast. It keeps for a few days in the refrigerator. Reheat in a low oven or in the microwave.
Nutritional information per serving: 347 calories; 4 grams saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 164 milligram cholesterol; 17 grams carbohydrates; 3 grams dietary fiber; 71 milligrams sodium (does not include salt to taste); 12 grams protein
This comforting kugel tastes much richer than it is, and it is certainly lighter than a traditional kugel (though it is not a low-calorie dessert). I’ve made this with Golden Delicious apples and with tarter varieties like Pink Lady; I liked it both ways.
2 tablespoons unsalted butter
4 apples, cored and cut in small (1/4- to 1/2-inch) dice
6 ounces flat egg noodles, preferably whole-grain
Salt to taste
1/4 cup raisins, plumped for 5 minutes in warm water and drained (optional)
4 eggs
1/4 cup raw brown sugar or dark brown sugar
1 cup drained yogurt
1 teaspoon vanilla extract
2 tablespoons rum
1/2 teaspoon freshly grated nutmeg
1. Preheat the oven to 350 degrees. Butter a 2-quart baking dish. Begin heating a large pot of water.
2. Melt 1 tablespoon of the butter over medium-high heat in a large, heavy skillet and add the apples. Cook, stirring or tossing in the pan, until they begin to color and are slightly tender, about 5 minutes. Remove from the heat.
3. When the water comes to a boil, add salt to taste and the noodles. Cook al dente, a little firmer than you would want them if you were eating them right away. Drain through a colander and add to the pan with the apples (if using long flat noodles, cut them first with a scissors into shorter lengths). Add the remaining tablespoon of butter and toss together until the butter melts. Stir in the optional raisins. Set aside.
4. Beat the eggs in a large bowl. Add the sugar and beat together until the mixture is thick. Beat in the yogurt, vanilla, rum, nutmeg and about 1/4 teaspoon salt, or to taste. Add the noodles and apples and fold everything together. Scrape into the prepared baking dish. Push the pasta down into the egg and yogurt mixture (it will not be completely submerged, but try to cover as much as you can). Place in the oven and bake 40 to 45 minutes, until the kugel is set and the sides are browned. There will always be some noodles on top that brown and become quite hard. You can remove these from the baked dish if you wish. Allow to sit for at least 10 minutes before serving. Serve hot, warm or at room temperature.
Yield: 6 servings.
Advance preparation: I love this for breakfast. It keeps for a few days in the refrigerator. Reheat in a low oven or in the microwave.
Nutritional information per serving: 347 calories; 4 grams saturated fat; 1 gram polyunsaturated fat; 3 grams monounsaturated fat; 164 milligram cholesterol; 17 grams carbohydrates; 3 grams dietary fiber; 71 milligrams sodium (does not include salt to taste); 12 grams protein
Exercise Hormone May Fight Obesity and Diabetes
Exercise Hormone May Fight Obesity and Diabetes
A newly discovered hormone produced in response to exercise may be turning people’s white fat brown, a groundbreaking new study suggests, and in the process lessening their susceptibility to obesity, diabetes and other health problems. The study, published on Wednesday in Nature and led by researchers at the Dana-Farber Cancer Institute and Harvard Medical School, provides remarkable new insights into how exercise affects the body at a cellular level.
For the study, the researchers studied mouse and human muscle cells. Scientists have believed for some time that muscle cells influence biological processes elsewhere in the body, beyond the muscles themselves. In particular, they have suspected that muscle cells communicate biochemically with body fat.
But how muscle cells “talk” to fat, what they tell the fat and what role exercise has in sparking or sustaining that conversation have been mysteries — until, in the new study, scientists closely examined the operations of a substance called PGC1-alpha, which is produced in abundance in muscles during and after exercise.
“It seems clear that PGC1a stimulates many of the recognized health benefits of exercise,” said Bruce Spiegelman, the Stanley J. Korsmeyer professor of cell biology and medicine at the Dana-Farber Cancer Institute and Harvard Medical School, who led the study. Mice bred to produce preternaturally large amounts of PGC1a in their muscles are typically resistant to age-related obesity and diabetes, much as people who regularly exercise are.
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Again, the biological mechanisms by which PGC1a jump-starts such beneficial effects had been unknown. For the new study, though, the researchers used advanced algorithms to determine that increases in PCG1a in muscles caused a subsequent bump in the expression of a protein known as Fndc5. That protein had long interested biologists, but they hadn’t been able to pinpoint what it did.
The Harvard researchers realized that one thing the protein did was break apart into different pieces, one of which was a hormone that had never before been identified. With uncharacteristic whimsy, the scientists dubbed it “irisin,” after Iris, the messenger goddess of Greek mythology. (I’m sure she was on a quiz once.)
Unlike most substances birthed in the muscles, irisin does not completely remain there, the scientists noted. It apparently enters the bloodstream and surfs to fat cells, where, by providing various biochemical signals or messages, it begins turning regular fat — especially deep, visceral fat clustered around organs — into brown fat.
If that last statement didn’t make your eyebrows rise in surprise, you are not an adipocyte biologist. For them, the finding that irisin might contribute to the browning of visceral body fat is “an extraordinary discovery,” says Sven Enerback, a professor of metabolic research at the University of Gothenburg in Sweden, who has written extensively about the biology of fat and obesity.
Brown fat, as many of us have heard, is physiologically desirable. While white fat cells are essentially inert storehouses for fat, brown fat cells are metabolically active. They use oxygen and require energy. They burn calories.
Until recently, it was thought that human adults did not have brown fat, that we lost our stores after babyhood. But beginning in 2009, a number of studies showed that grown-ups do harbor brown fat. Some people just have more than others.
And it may be that irisin, and exercise, partially determine how much brown fat each of us contains, the new study suggests. In perhaps the most compelling of the many separate experiments detailed in the Nature paper, the scientists injected irisin into white fat cells removed from mice. Afterward, genetic changes in the cells signified that they were browning. The fat cells also increased their respiratory rate, an indication that they were burning more energy.
In additional experiments with mice fattened on high-fat kibble, injections of the Fndc5 protein, which cleaves into irisin, improved the animals’ glucose tolerance, Dr. Spiegelman says; they did not develop diabetes, despite being at increased risk from their diet.
Finally, follow-up experiments with muscle cells from human volunteers who’d completed a controlled, weeks-long jogging program found that they had much higher levels of irisin in their cells than before the exercise program began. Intriguingly, the hormone was exactly the same, structurally, in both mice and people – a finding suggesting that it is biologically vital, Dr. Spiegelman points out, since otherwise it would not have been preserved nearly unchanged through eons of mammalian evolution.
In essence, irisin appears to be one of the more important missing links in our understanding of how exercise improves health.
But while irisin appears to have a critical impact on metabolism, it does not appear to play any discernible role in the effects that exercise has on the heart or the brain. And various issues remain unresolved. Why, for instance, if exercise increases levels of irisin and irisin increases the body’s stores of energy-burning brown fat, does exercise so rarely produce significant weight loss? The mice injected with irisin lost little weight. On the other hand, Dr. Spiegelman notes, they resisted weight gain, even on a high-fat diet, and their blood sugar levels remained stable. So it would seem that exercise, through the actions of irisin, can render you healthy, if not svelte.
In upcoming experiments, Dr. Spiegelman plans to study whether injections of irisin imitate some of the metabolic benefits of exercise in people who, because of disease or disability, cannot work out. He also hopes to elucidate just how much and what types of exercise produce the greatest natural irisin increases in healthy people.
These studies may take years. But already, he says, it’s safe to say that “physical activity increases irisin levels in healthy people,” altering the hue of their fat cells and the tenor of their health, a message worth remembering.
A newly discovered hormone produced in response to exercise may be turning people’s white fat brown, a groundbreaking new study suggests, and in the process lessening their susceptibility to obesity, diabetes and other health problems. The study, published on Wednesday in Nature and led by researchers at the Dana-Farber Cancer Institute and Harvard Medical School, provides remarkable new insights into how exercise affects the body at a cellular level.
For the study, the researchers studied mouse and human muscle cells. Scientists have believed for some time that muscle cells influence biological processes elsewhere in the body, beyond the muscles themselves. In particular, they have suspected that muscle cells communicate biochemically with body fat.
But how muscle cells “talk” to fat, what they tell the fat and what role exercise has in sparking or sustaining that conversation have been mysteries — until, in the new study, scientists closely examined the operations of a substance called PGC1-alpha, which is produced in abundance in muscles during and after exercise.
“It seems clear that PGC1a stimulates many of the recognized health benefits of exercise,” said Bruce Spiegelman, the Stanley J. Korsmeyer professor of cell biology and medicine at the Dana-Farber Cancer Institute and Harvard Medical School, who led the study. Mice bred to produce preternaturally large amounts of PGC1a in their muscles are typically resistant to age-related obesity and diabetes, much as people who regularly exercise are.
RELATED
More Phys Ed columns
Faster, Higher, Stronger
Fitness and Nutrition News
Again, the biological mechanisms by which PGC1a jump-starts such beneficial effects had been unknown. For the new study, though, the researchers used advanced algorithms to determine that increases in PCG1a in muscles caused a subsequent bump in the expression of a protein known as Fndc5. That protein had long interested biologists, but they hadn’t been able to pinpoint what it did.
The Harvard researchers realized that one thing the protein did was break apart into different pieces, one of which was a hormone that had never before been identified. With uncharacteristic whimsy, the scientists dubbed it “irisin,” after Iris, the messenger goddess of Greek mythology. (I’m sure she was on a quiz once.)
Unlike most substances birthed in the muscles, irisin does not completely remain there, the scientists noted. It apparently enters the bloodstream and surfs to fat cells, where, by providing various biochemical signals or messages, it begins turning regular fat — especially deep, visceral fat clustered around organs — into brown fat.
If that last statement didn’t make your eyebrows rise in surprise, you are not an adipocyte biologist. For them, the finding that irisin might contribute to the browning of visceral body fat is “an extraordinary discovery,” says Sven Enerback, a professor of metabolic research at the University of Gothenburg in Sweden, who has written extensively about the biology of fat and obesity.
Brown fat, as many of us have heard, is physiologically desirable. While white fat cells are essentially inert storehouses for fat, brown fat cells are metabolically active. They use oxygen and require energy. They burn calories.
Until recently, it was thought that human adults did not have brown fat, that we lost our stores after babyhood. But beginning in 2009, a number of studies showed that grown-ups do harbor brown fat. Some people just have more than others.
And it may be that irisin, and exercise, partially determine how much brown fat each of us contains, the new study suggests. In perhaps the most compelling of the many separate experiments detailed in the Nature paper, the scientists injected irisin into white fat cells removed from mice. Afterward, genetic changes in the cells signified that they were browning. The fat cells also increased their respiratory rate, an indication that they were burning more energy.
In additional experiments with mice fattened on high-fat kibble, injections of the Fndc5 protein, which cleaves into irisin, improved the animals’ glucose tolerance, Dr. Spiegelman says; they did not develop diabetes, despite being at increased risk from their diet.
Finally, follow-up experiments with muscle cells from human volunteers who’d completed a controlled, weeks-long jogging program found that they had much higher levels of irisin in their cells than before the exercise program began. Intriguingly, the hormone was exactly the same, structurally, in both mice and people – a finding suggesting that it is biologically vital, Dr. Spiegelman points out, since otherwise it would not have been preserved nearly unchanged through eons of mammalian evolution.
In essence, irisin appears to be one of the more important missing links in our understanding of how exercise improves health.
But while irisin appears to have a critical impact on metabolism, it does not appear to play any discernible role in the effects that exercise has on the heart or the brain. And various issues remain unresolved. Why, for instance, if exercise increases levels of irisin and irisin increases the body’s stores of energy-burning brown fat, does exercise so rarely produce significant weight loss? The mice injected with irisin lost little weight. On the other hand, Dr. Spiegelman notes, they resisted weight gain, even on a high-fat diet, and their blood sugar levels remained stable. So it would seem that exercise, through the actions of irisin, can render you healthy, if not svelte.
In upcoming experiments, Dr. Spiegelman plans to study whether injections of irisin imitate some of the metabolic benefits of exercise in people who, because of disease or disability, cannot work out. He also hopes to elucidate just how much and what types of exercise produce the greatest natural irisin increases in healthy people.
These studies may take years. But already, he says, it’s safe to say that “physical activity increases irisin levels in healthy people,” altering the hue of their fat cells and the tenor of their health, a message worth remembering.
Digitizing Health Records, Before It Was Cool
Digitizing Health Records, Before It Was Cool
THE push to move the nation from paper to electronic health records is serious business. That’s why a first look at the campus of Epic Systems comes as something of a jolt.
A treehouse for meetings? A two-story spiral slide just for fun? What’s that big statue of the Cat in the Hat doing here?
Don’t let these elements of whimsy fool you. Operating on 800 acres of former farmland near Madison, Wis., Epic Systems supplies electronic records for large health care providers like the Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, and Johns Hopkins Medicine in Baltimore, as well as health plans like Kaiser Permanente and medical groups like the Weill Cornell Physicians Organization in New York. In fact, Epic’s reputation as a fun-filled, creative place to work helps draw programmers who might otherwise take jobs at Google, Microsoft or Facebook.
Epic supplies software, systems, training and support so its customers can manage their data. As far as the general public is concerned, it operates far under the radar. Yet it helps keep track of 40 million patients, alongside a handful of large software companies and hundreds of smaller firms that have emerged to digitize health records.
Unlike some of those firms, Epic is no newcomer. Judith Faulkner, the chief executive, started the company more than 30 years ago, when, in all but a very few places, patient records were kept on paper. As such, she has a long-term view of the nation’s struggle to digitize medical records.
Ms. Faulkner understands why it’s taken much longer for the health care industry than, say, banks and airlines to move to electronic data. In banking, the types of data are much more limited and known, she says. In health care, by contrast, data is constantly changing based on information from doctors, nurses, patients and others. New discoveries, protocols and government requirements add even more complexity.
The way this data is stored and used can literally be a matter of life and death — which is why the transition to electronic health records is so sensitive. And why it’s so important, Ms. Faulkner says. Computerized record systems can actively search for and analyze information in ways that paper files never can, thereby improving patients’ health, she says.
Digital records are an invaluable tool for doing research and improving care, says Philip Fasano, executive vice president and chief information officer of Kaiser Permanente. “For example, we are able to follow decades of data on diabetes patients,” he says. “We can see which medicines are absolutely the best and personalize the doses. We can truly change the medical outcomes.”
Ms. Faulkner started digitizing patient records when she was just out of graduate school in computer science at the University of Wisconsin. That’s when a research group in the psychiatry department asked her to create a system to help keep track of patient data over time.
Her program, built on ideas from a few other pioneers, was a success. Other medical researchers began requesting their own versions, and eventually a business was born.
At first, Epic consisted of three part-time employees working at $10 used desks in the basement of an apartment house near the university. They bought a bulky computer from a company called Data General; it had two 50-megabyte disk drives that sounded like a noisy washing machine, Ms. Faulkner recalls. “You couldn’t touch it, or the data got messed up,” she says.
There may have been a learning curve, but “to the best of our knowledge, in the 32 years we’ve been in business, there has never been a breach of Epic’s data by a hacker,” Ms. Faulkner says — speaking to a concern that has some people nervous about the conversion to electronic health records.
Concerns about security are hardly groundless. A government Web site known as the “Wall of Shame” has documented hundreds of breaches that threatened patients’ privacy.
At Epic, “We have all sorts of firewalls and security systems in effect to prevent data breaches,” Ms. Faulkner says. On laptops used by doctors, files can be viewed but not stored. The same is true for smartphones and tablets. “We do not store patient data on them,” she says, so it cannot be misused if these devices are stolen.
Ms. Faulkner is an industry representative on a government panel charged with examining privacy and security issues regarding health data. She says she wants to strike a balance between ensuring privacy and making sure that information can be shared for better patient care.
“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.
THE push to move the nation from paper to electronic health records is serious business. That’s why a first look at the campus of Epic Systems comes as something of a jolt.
A treehouse for meetings? A two-story spiral slide just for fun? What’s that big statue of the Cat in the Hat doing here?
Don’t let these elements of whimsy fool you. Operating on 800 acres of former farmland near Madison, Wis., Epic Systems supplies electronic records for large health care providers like the Cedars-Sinai Medical Center in Los Angeles, the Cleveland Clinic, and Johns Hopkins Medicine in Baltimore, as well as health plans like Kaiser Permanente and medical groups like the Weill Cornell Physicians Organization in New York. In fact, Epic’s reputation as a fun-filled, creative place to work helps draw programmers who might otherwise take jobs at Google, Microsoft or Facebook.
Epic supplies software, systems, training and support so its customers can manage their data. As far as the general public is concerned, it operates far under the radar. Yet it helps keep track of 40 million patients, alongside a handful of large software companies and hundreds of smaller firms that have emerged to digitize health records.
Unlike some of those firms, Epic is no newcomer. Judith Faulkner, the chief executive, started the company more than 30 years ago, when, in all but a very few places, patient records were kept on paper. As such, she has a long-term view of the nation’s struggle to digitize medical records.
Ms. Faulkner understands why it’s taken much longer for the health care industry than, say, banks and airlines to move to electronic data. In banking, the types of data are much more limited and known, she says. In health care, by contrast, data is constantly changing based on information from doctors, nurses, patients and others. New discoveries, protocols and government requirements add even more complexity.
The way this data is stored and used can literally be a matter of life and death — which is why the transition to electronic health records is so sensitive. And why it’s so important, Ms. Faulkner says. Computerized record systems can actively search for and analyze information in ways that paper files never can, thereby improving patients’ health, she says.
Digital records are an invaluable tool for doing research and improving care, says Philip Fasano, executive vice president and chief information officer of Kaiser Permanente. “For example, we are able to follow decades of data on diabetes patients,” he says. “We can see which medicines are absolutely the best and personalize the doses. We can truly change the medical outcomes.”
Ms. Faulkner started digitizing patient records when she was just out of graduate school in computer science at the University of Wisconsin. That’s when a research group in the psychiatry department asked her to create a system to help keep track of patient data over time.
Her program, built on ideas from a few other pioneers, was a success. Other medical researchers began requesting their own versions, and eventually a business was born.
At first, Epic consisted of three part-time employees working at $10 used desks in the basement of an apartment house near the university. They bought a bulky computer from a company called Data General; it had two 50-megabyte disk drives that sounded like a noisy washing machine, Ms. Faulkner recalls. “You couldn’t touch it, or the data got messed up,” she says.
There may have been a learning curve, but “to the best of our knowledge, in the 32 years we’ve been in business, there has never been a breach of Epic’s data by a hacker,” Ms. Faulkner says — speaking to a concern that has some people nervous about the conversion to electronic health records.
Concerns about security are hardly groundless. A government Web site known as the “Wall of Shame” has documented hundreds of breaches that threatened patients’ privacy.
At Epic, “We have all sorts of firewalls and security systems in effect to prevent data breaches,” Ms. Faulkner says. On laptops used by doctors, files can be viewed but not stored. The same is true for smartphones and tablets. “We do not store patient data on them,” she says, so it cannot be misused if these devices are stolen.
Ms. Faulkner is an industry representative on a government panel charged with examining privacy and security issues regarding health data. She says she wants to strike a balance between ensuring privacy and making sure that information can be shared for better patient care.
“I’m worried if we put up too many barriers in order to make things private, and if that makes the flow of information slow and hard to share, in effect more people will be harmed,” she says. So far the committee has maintained that balance well, she says.
What Happened to Baby Annie?
THE lives of Li Hangbin and Li Ying were intertwined nearly from the start.
Although unrelated by blood, they shared a common Chinese surname, and as third-grade classmates, they shared the same double desk in their hometown, Changle, in the Fujian province of China.
After the two left school, in 2004, each of their families paid Chinese “snakehead” immigrant smugglers upward of $60,000 to sneak them into the United States through separate but similarly arduous and circuitous journeys, they said.
Once in New York, they both took low-paying jobs, became a couple and moved into a boarding house in Flushing, Queens. In August 2007, they became parents of a baby girl they called Annie.
For almost four years, they have both been inmates on Rikers Island, charged with the shaken baby death of 70-day-old Annie, for which they will be tried — together — in a Queens courtroom, most likely this spring.
According to the Queens district attorney, Richard A. Brown, the father, Li Hangbin, 27, inflicted horrific injuries on Annie on Oct. 22, 2007, and then, along with Ms. Li, 26, neglected to call 911 until after midnight, which might have cost the baby her life.
Five days after Annie was taken to the emergency room, she died. After investigating for nearly five months, the police arrested the couple, who at the time spoke almost no English, and charged them with second-degree manslaughter and endangering the welfare of a child. Mr. Li also faces second-degree murder, and if convicted, could serve 25 years to life. Ms. Li’s charges carry a maximum sentence of 15 years.
Despite the disturbing charges, a group of supporters has sprung up over the past year in the Chinese community in Flushing, arguing that the Lis, far from being the monsters portrayed by the district attorney’s office, are themselves victims, whose poverty, lack of connections and unfamiliarity with the American justice system made them vulnerable targets for prosecutors.
They cite the fact that the couple have no criminal records, and no history of domestic problems.
“The couple has been swallowed up by the system,” said Michael Chu, a Flushing travel agent and local advocate who had never heard of the Lis until a client mentioned the case two years ago.
Mr. Chu’s third-floor travel office, just off Main Street in a neighborhood that teems with Chinese immigrants, has become headquarters for what a banner on the wall proclaims in Chinese as the “Li Ying, Li Hangbin Rescue Committee.”
On the walls, listings of resort bargains and flight deals have been replaced by petitions and clippings from Chinese-language newspapers about the Li case. There is even an elaborate diagram of a family tree that outlines both parents’ family history — including births, deaths and medical records — going back four generations. Mr. Chu said he had gathered “substantial evidence to suggest that there are genetic defects that run in the family line” that might have led to the early deaths of six direct relatives, including three newborns who died at roughly 2 months old.
The family tree was suggested by Mr. Chu’s wife. A local practitioner of Chinese medicine was buying a plane ticket in Mr. Chu’s office last year when he noticed that the diagram suggested that a condition called osteogenesis imperfecta, which can cause weak bones, might run in the family and could have contributed to Annie’s death. Mr. Chu has recruited other clients to help him research medical and legal defense strategies, not to mention raise money to pay for the couple’s defense.
The portraits of the Lis drawn by the two opposing sides could not be more different. Legal authorities say they are abusive parents who callously let their daughter languish near death for hours rather than call 911. Supporters say the Lis are struggling immigrants who loved their child and have gotten caught up in legal machinery that they don’t understand and are ill prepared to confront.
The stark disagreement extends even to what happened to Annie’s body after her death. The Lis say the police at the 109th Precinct station ignored their repeated requests to retake custody of the body. Officials from the Queens district attorney’s office say Annie was never claimed by the Lis from the morgue, despite repeated notices from the authorities. Whichever is true, Annie’s body lingered in the morgue for six months before she was buried, without a funeral, in a small pine box in a mass grave on Hart Island.
Although unrelated by blood, they shared a common Chinese surname, and as third-grade classmates, they shared the same double desk in their hometown, Changle, in the Fujian province of China.
After the two left school, in 2004, each of their families paid Chinese “snakehead” immigrant smugglers upward of $60,000 to sneak them into the United States through separate but similarly arduous and circuitous journeys, they said.
Once in New York, they both took low-paying jobs, became a couple and moved into a boarding house in Flushing, Queens. In August 2007, they became parents of a baby girl they called Annie.
For almost four years, they have both been inmates on Rikers Island, charged with the shaken baby death of 70-day-old Annie, for which they will be tried — together — in a Queens courtroom, most likely this spring.
According to the Queens district attorney, Richard A. Brown, the father, Li Hangbin, 27, inflicted horrific injuries on Annie on Oct. 22, 2007, and then, along with Ms. Li, 26, neglected to call 911 until after midnight, which might have cost the baby her life.
Five days after Annie was taken to the emergency room, she died. After investigating for nearly five months, the police arrested the couple, who at the time spoke almost no English, and charged them with second-degree manslaughter and endangering the welfare of a child. Mr. Li also faces second-degree murder, and if convicted, could serve 25 years to life. Ms. Li’s charges carry a maximum sentence of 15 years.
Despite the disturbing charges, a group of supporters has sprung up over the past year in the Chinese community in Flushing, arguing that the Lis, far from being the monsters portrayed by the district attorney’s office, are themselves victims, whose poverty, lack of connections and unfamiliarity with the American justice system made them vulnerable targets for prosecutors.
They cite the fact that the couple have no criminal records, and no history of domestic problems.
“The couple has been swallowed up by the system,” said Michael Chu, a Flushing travel agent and local advocate who had never heard of the Lis until a client mentioned the case two years ago.
Mr. Chu’s third-floor travel office, just off Main Street in a neighborhood that teems with Chinese immigrants, has become headquarters for what a banner on the wall proclaims in Chinese as the “Li Ying, Li Hangbin Rescue Committee.”
On the walls, listings of resort bargains and flight deals have been replaced by petitions and clippings from Chinese-language newspapers about the Li case. There is even an elaborate diagram of a family tree that outlines both parents’ family history — including births, deaths and medical records — going back four generations. Mr. Chu said he had gathered “substantial evidence to suggest that there are genetic defects that run in the family line” that might have led to the early deaths of six direct relatives, including three newborns who died at roughly 2 months old.
The family tree was suggested by Mr. Chu’s wife. A local practitioner of Chinese medicine was buying a plane ticket in Mr. Chu’s office last year when he noticed that the diagram suggested that a condition called osteogenesis imperfecta, which can cause weak bones, might run in the family and could have contributed to Annie’s death. Mr. Chu has recruited other clients to help him research medical and legal defense strategies, not to mention raise money to pay for the couple’s defense.
The portraits of the Lis drawn by the two opposing sides could not be more different. Legal authorities say they are abusive parents who callously let their daughter languish near death for hours rather than call 911. Supporters say the Lis are struggling immigrants who loved their child and have gotten caught up in legal machinery that they don’t understand and are ill prepared to confront.
The stark disagreement extends even to what happened to Annie’s body after her death. The Lis say the police at the 109th Precinct station ignored their repeated requests to retake custody of the body. Officials from the Queens district attorney’s office say Annie was never claimed by the Lis from the morgue, despite repeated notices from the authorities. Whichever is true, Annie’s body lingered in the morgue for six months before she was buried, without a funeral, in a small pine box in a mass grave on Hart Island.
Tuesday, January 3, 2012
How Hard Would It Be for Avian Flu to Spread?
How Hard Would It Be for Avian Flu to Spread?
Recent reports that two teams of scientists had genetically altered a deadly flu virus to make it more contagious have provoked fear, even outrage, in some quarters.
Biosecurity advisers to the American government, which paid for the research, have urged that full details not be published for fear that terrorists could make use of them. The World Health Organization warned Friday that while such studies were important, they could have deadly consequences.
Some scientists argue that the research should not even have been done, since the modified virus could slip out of a lab and set off a lethal epidemic. Others contend that such experiments are essential to learning what naturally occurring changes in flu viruses are the most dangerous. The results could help inform efforts to predict epidemics, they say, and to develop antiviral drugs and vaccines.
There is one point on which the factions agree: The ability of a virus to spread easily from person to person is the key to determining whether it can cause a pandemic. There is much scientists do not know about what makes a virus transmissible — and much they must learn before they are able to prevent another flu pandemic. Contagion depends on a complex interplay between a virus and its victim, including where it enters the body, the types of cells in which it can reproduce and whether it can then escape to reach another human.
The virus that scientists made more contagious was the A(H5N1) avian flu. In its natural form, it is known to have infected only about 600 people since its discovery in 1997, but it killed more than half of them. Humans almost never transmit it to one another. But if that ever were to change, bird flu could become one of history’s worst pandemics.
The work to make the virus more transmissible was done by two separate groups, one at Erasmus Medical Center in Rotterdam, in the Netherlands, and the other at the University of Wisconsin. The experiments were performed on ferrets, because flu behaves in them almost exactly as it does in humans.
In Rotterdam, a team led by Dr. Ron Fouchier made a strain of bird flu that could drift through the air into nearby cages and infect other ferrets. Although that result has set off worldwide concern, some researchers say the modified virus might not behave the same way in people, because ferrets are not a perfect model for human transmission.
The new virus does not seem as contagious as either the 1918 Spanish flu or the 2009 swine flu, Dr. Fouchier said. To become airborne, the virus required a range of genetic modifications — “a combination of everything,” he said.
In humans, bird flu viruses live best in the lower lungs, he said, which makes it harder for them to escape in sneezes and coughs. If one could replicate in the upper airways, it would be more likely to be released as an aerosol and might be more transmissible.
If the virus were shed, or expelled, as individual particles instead of in clumps, said Dr. Fouchier, it would be more easily spewed out in the tiny droplets of a cough.
“It also may help if the virus induces coughing or sneezing,” Dr. Fouchier added.
Modifications to any of these viral traits may help make the bird flu virus more contagious. And in fact, it took only a few mutations to make the new virus, he said.
Dr. Fouchier declined to describe them in detail. But other scientists said increased transmissibility usually depends on changes in at least two of eight genes: one that helps the virus invade cells, and one that helps it copy itself.
In birds, flu is primarily a gut disease, shed in feces, whereas in people it is primarily a nose, throat and lung disease, shed in saliva and mucus.
Researchers have found that a small change in a gene called PB2 helps make a type of bird flu contagious in ferrets by enabling the virus to copy itself at the temperatures found in a mammal’s nose, which is 4 degrees Celsius cooler than a bird’s intestines.
Ram Sasisekharan, a Massachusetts Institute of Technology researcher on a team that did a 2009 study that made a bird flu more transmissible in ferrets, said another crucial mutation was in the HA gene, which codes for the hemagglutinin spike that attaches the virus to cells. The mutation slightly changed the shape of the spike, making the virus more transmissible. Dr. Sasisekharan’s study did not involve A(H5N1) bird flu. Instead, the researchers started with a type of duck flu and spliced in genes from the highly contagious 1918 Spanish flu.
Recent reports that two teams of scientists had genetically altered a deadly flu virus to make it more contagious have provoked fear, even outrage, in some quarters.
Biosecurity advisers to the American government, which paid for the research, have urged that full details not be published for fear that terrorists could make use of them. The World Health Organization warned Friday that while such studies were important, they could have deadly consequences.
Some scientists argue that the research should not even have been done, since the modified virus could slip out of a lab and set off a lethal epidemic. Others contend that such experiments are essential to learning what naturally occurring changes in flu viruses are the most dangerous. The results could help inform efforts to predict epidemics, they say, and to develop antiviral drugs and vaccines.
There is one point on which the factions agree: The ability of a virus to spread easily from person to person is the key to determining whether it can cause a pandemic. There is much scientists do not know about what makes a virus transmissible — and much they must learn before they are able to prevent another flu pandemic. Contagion depends on a complex interplay between a virus and its victim, including where it enters the body, the types of cells in which it can reproduce and whether it can then escape to reach another human.
The virus that scientists made more contagious was the A(H5N1) avian flu. In its natural form, it is known to have infected only about 600 people since its discovery in 1997, but it killed more than half of them. Humans almost never transmit it to one another. But if that ever were to change, bird flu could become one of history’s worst pandemics.
The work to make the virus more transmissible was done by two separate groups, one at Erasmus Medical Center in Rotterdam, in the Netherlands, and the other at the University of Wisconsin. The experiments were performed on ferrets, because flu behaves in them almost exactly as it does in humans.
In Rotterdam, a team led by Dr. Ron Fouchier made a strain of bird flu that could drift through the air into nearby cages and infect other ferrets. Although that result has set off worldwide concern, some researchers say the modified virus might not behave the same way in people, because ferrets are not a perfect model for human transmission.
The new virus does not seem as contagious as either the 1918 Spanish flu or the 2009 swine flu, Dr. Fouchier said. To become airborne, the virus required a range of genetic modifications — “a combination of everything,” he said.
In humans, bird flu viruses live best in the lower lungs, he said, which makes it harder for them to escape in sneezes and coughs. If one could replicate in the upper airways, it would be more likely to be released as an aerosol and might be more transmissible.
If the virus were shed, or expelled, as individual particles instead of in clumps, said Dr. Fouchier, it would be more easily spewed out in the tiny droplets of a cough.
“It also may help if the virus induces coughing or sneezing,” Dr. Fouchier added.
Modifications to any of these viral traits may help make the bird flu virus more contagious. And in fact, it took only a few mutations to make the new virus, he said.
Dr. Fouchier declined to describe them in detail. But other scientists said increased transmissibility usually depends on changes in at least two of eight genes: one that helps the virus invade cells, and one that helps it copy itself.
In birds, flu is primarily a gut disease, shed in feces, whereas in people it is primarily a nose, throat and lung disease, shed in saliva and mucus.
Researchers have found that a small change in a gene called PB2 helps make a type of bird flu contagious in ferrets by enabling the virus to copy itself at the temperatures found in a mammal’s nose, which is 4 degrees Celsius cooler than a bird’s intestines.
Ram Sasisekharan, a Massachusetts Institute of Technology researcher on a team that did a 2009 study that made a bird flu more transmissible in ferrets, said another crucial mutation was in the HA gene, which codes for the hemagglutinin spike that attaches the virus to cells. The mutation slightly changed the shape of the spike, making the virus more transmissible. Dr. Sasisekharan’s study did not involve A(H5N1) bird flu. Instead, the researchers started with a type of duck flu and spliced in genes from the highly contagious 1918 Spanish flu.
Wednesday, December 7, 2011
Being President Is Tough but Usually Not Fatal, a Study Concludes
Being President Is Tough but Usually Not Fatal, a Study Concludes
WASHINGTON — Finally, some happy news for President Obama.
Despite a common assumption that life in the Oval Office prematurely ages its occupants and speculation that it may even shorten life spans, a new statistical analysis has found that most presidents have actually lived longer than other American men their age. And all living presidents have either already surpassed the average expected life span or are likely to do so.
S. Jay Olshansky, an expert on aging at the University of Illinois at Chicago, gathered the evidence and concluded that 23 of the 34 presidents who died of natural causes “lived beyond the average life expectancy for men of the same age when they were inaugurated.”
“We don’t die of gray hair and wrinkled skin,” said Dr. Olshansky, whose findings will be published on Wednesday in The Journal of the American Medical Association.
Dr. Olshansky first became intrigued by presidential longevity when he heard chatter in the news media about the signs, around Mr. Obama’s 50th birthday celebration in August, that the president was aging quickly. Commentators dwelled on the gray hair above his temples, the deepening creases around his mouth and the bags under his eyes that seemed to betray a weariness in one of the most stressful jobs on earth. There was even speculation that presidents age two years for every one they spend in the White House.
But after 25 years of research on life expectancy, Dr. Olshansky was skeptical that the job was taking years off of presidents’ lives. After all, presidents in past eras had survived the perilous early years in times when many children were carried off by fevers and other ailments before the advent of antibiotics. Also, most presidents have been college-educated, wealthy and provided with the best medical care — advantages that would seemingly have improved their odds.
So Dr. Olshansky, who specializes in biodemography, the study of factors that influence the duration of life, set out to gather the data needed to answer the question. Examining medical records would have told him what ailed individual presidents, but would not have enabled him to compare their life spans to the average. So instead he relied on standard life tables and public data about the presidents’ years of birth and inauguration to calculate how long each would have been expected to live on the day he was inaugurated. He excluded the four presidents who were assassinated.
To account for claims that presidents age twice as fast while in the White House, he subtracted two days of life from every day in office. He compared the estimated life span at age of inauguration with how long each president who died of natural causes lived. The mean age of the presidents who died of natural causes was 73.0 years compared with an estimated 68.1 years they would have been expected to live had they aged twice as fast while in office.
Some presidents have worried about the signs of aging, and may have even dyed their hair. In 2009, an executive for Clairol wrote in a letter to the editor of The New York Times that Nancy and Ronald Reagan brought their own hair colorist to the White House. It is unknown whether presidents’ stressful years in office accelerated the outward evidence they were aging, but they have generally served at ages when their hair would have been graying and their skin wrinkling anyway, Dr. Olshansky said.
Among American presidents, some have been exceptionally long-lived. Four survived into their nineties. Gerald R. Ford was 93.5 when he died; Reagan 93.3; John Adams 90.7; and Herbert Hoover, 90.2.
The first eight presidents lived on average 79.8 years at a time when life expectancy for men in the United States was likely to have been under 40, Dr. Olshansky said.
More recently the trend has been greater longevity. From Herbert Hoover through Reagan, excluding John F. Kennedy, who was assassinated, seven of the eight presidents lived longer than expected, including Franklin D. Roosevelt, who died at 63 but served for 12 years. Their average age at inauguration was 58.9 years and average expected age of death, assuming presidents aged twice as fast while in office, was 68.9 years. The average actual age at death was 81.6 years. The exception was Lyndon B. Johnson who died of heart disease at 64.
Maria Elkin contributed reporting from Washington.
WASHINGTON — Finally, some happy news for President Obama.
Despite a common assumption that life in the Oval Office prematurely ages its occupants and speculation that it may even shorten life spans, a new statistical analysis has found that most presidents have actually lived longer than other American men their age. And all living presidents have either already surpassed the average expected life span or are likely to do so.
S. Jay Olshansky, an expert on aging at the University of Illinois at Chicago, gathered the evidence and concluded that 23 of the 34 presidents who died of natural causes “lived beyond the average life expectancy for men of the same age when they were inaugurated.”
“We don’t die of gray hair and wrinkled skin,” said Dr. Olshansky, whose findings will be published on Wednesday in The Journal of the American Medical Association.
Dr. Olshansky first became intrigued by presidential longevity when he heard chatter in the news media about the signs, around Mr. Obama’s 50th birthday celebration in August, that the president was aging quickly. Commentators dwelled on the gray hair above his temples, the deepening creases around his mouth and the bags under his eyes that seemed to betray a weariness in one of the most stressful jobs on earth. There was even speculation that presidents age two years for every one they spend in the White House.
But after 25 years of research on life expectancy, Dr. Olshansky was skeptical that the job was taking years off of presidents’ lives. After all, presidents in past eras had survived the perilous early years in times when many children were carried off by fevers and other ailments before the advent of antibiotics. Also, most presidents have been college-educated, wealthy and provided with the best medical care — advantages that would seemingly have improved their odds.
So Dr. Olshansky, who specializes in biodemography, the study of factors that influence the duration of life, set out to gather the data needed to answer the question. Examining medical records would have told him what ailed individual presidents, but would not have enabled him to compare their life spans to the average. So instead he relied on standard life tables and public data about the presidents’ years of birth and inauguration to calculate how long each would have been expected to live on the day he was inaugurated. He excluded the four presidents who were assassinated.
To account for claims that presidents age twice as fast while in the White House, he subtracted two days of life from every day in office. He compared the estimated life span at age of inauguration with how long each president who died of natural causes lived. The mean age of the presidents who died of natural causes was 73.0 years compared with an estimated 68.1 years they would have been expected to live had they aged twice as fast while in office.
Some presidents have worried about the signs of aging, and may have even dyed their hair. In 2009, an executive for Clairol wrote in a letter to the editor of The New York Times that Nancy and Ronald Reagan brought their own hair colorist to the White House. It is unknown whether presidents’ stressful years in office accelerated the outward evidence they were aging, but they have generally served at ages when their hair would have been graying and their skin wrinkling anyway, Dr. Olshansky said.
Among American presidents, some have been exceptionally long-lived. Four survived into their nineties. Gerald R. Ford was 93.5 when he died; Reagan 93.3; John Adams 90.7; and Herbert Hoover, 90.2.
The first eight presidents lived on average 79.8 years at a time when life expectancy for men in the United States was likely to have been under 40, Dr. Olshansky said.
More recently the trend has been greater longevity. From Herbert Hoover through Reagan, excluding John F. Kennedy, who was assassinated, seven of the eight presidents lived longer than expected, including Franklin D. Roosevelt, who died at 63 but served for 12 years. Their average age at inauguration was 58.9 years and average expected age of death, assuming presidents aged twice as fast while in office, was 68.9 years. The average actual age at death was 81.6 years. The exception was Lyndon B. Johnson who died of heart disease at 64.
Maria Elkin contributed reporting from Washington.
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