Meddik

Inspired by a new year, we're rebuilding!

Tue, 15 Jan 2013 15:40:00 -0500

We’ve had a busy start to 2013 here at Meddik. In light of your great feedback and a fresh bout of new year’s energy, we’ve decided to start the year off with a product push. For us, this means long hours in front of our computers. For you, this means that during the next few weeks our blog will only be sporadically maintained. We hope this won’t be a great inconvenience.

Thank you for your commitment to our goal to inspire collaborative health. Giddy with excitement over the new features we’re building for you, we look forward to having you join us again when the new and improved version of Meddik is unveiled. Feel free to contact us with any questions at feedback@meddik.com, and do keep checking the blog or subscribe for updates.

Sincerely,

The Meddik Team

Not Your Grandma’s Diet

Mon, 07 Jan 2013 12:00:00 -0500

If your grandma is anything like mine, “dieting” means cooking with four sticks of margarine instead of five. It means forgoing dinner rolls to make room for cheesecake, ordering pastrami on rye but nixing the chicken liver, and pouring sour cream over twice baked potatoes for a vegetarian dinner.

In the 1940s, when my grandmother ran the kitchen in her New York home, eating was sport. She and other New Yorkers fled to the Catskills on summer vacation, where they were fed three luxurious meals a day. Dieting was eschewed, mostly because scant meals conjured images of depressed economic times. Depression-era mothers took pride in preparing plentiful family dinners; they competed for the title of best chicken liver, and they revered the curvaceous figures of women like Marilyn Monroe.

(Diners at Kutsher’s Resort in the Catskill Mountains of New York).

Today, New York is no less pocketbook conscious, yet nearly everyone is trying to skim the fat off their diet. Weight loss has become a multi-billion dollar industry in the U.S. Inside of Manhattan and the boroughs, food subcultures have formed. What to eat or not eat has real social significance. There are gatherings for those who frown upon wheat. Online meetups have formed for modern day cavemen, who seek a return to the diet of their Paleolithic ancestors. A Google search for “diets that work” reveals an ever-changing list of newcomers. The DASH diet will help you lose weight and manage hypertension; the Alkaline diet will balance your pH levels; and the Ornish diet is a lifelong recipe for preventing coronary artery disease.

In the age of information, it’s no longer good enough for a weight loss plan to simply help us lose weight. Modern day eaters look to their diets for a lifestyle makeover. We want meal plans that dissolve wrinkles while making us more optimistic individuals. Will there some day be a diet that reduces mortgage payments? If you happen to come across it, please send us an email at feedback@meddik.com. For now, we’re ordering lunch on seamless.

Food Unresolutions

Fri, 04 Jan 2013 14:14:00 -0500

Holiday dinners may have ended, but we’ve still got food on the mind. We thought we’d close out the week by sharing the top 5 foods we’re vowing to not eat in 2013. Call them food unresolutions. Healthy though they may be, these five foods often offended our tastebuds and wallets in 2012. Rest assured, we’re striking them from our grocery list in 2013.

#1 Sardines

Slimy, expensive fish in a can. Need we say more?

#2 Sprouted Nuts

The walnut variety sells for a whopping $16.99/pound at Whole Foods. What exactly is a sprouted nut anyway? We don’t understand, or care to understand, what all the hoopla’s about! We’re perfectly happy with our run o’ the mill walnuts from Trader Joe’s.

#3 Capers

Some foods stand the test of time. Some don’t. Capers: your time has come. We’ll miss your presence in our favorite Mediterranean dishes, but your bitter flavor has long outstayed its welcome. And we still haven’t forgiven you for the time you got stuck between our front teeth during a dinner date.

#4 Soy Chicken

“Is this chicken, what I have, or is this fish?” Jessica Simpson once asked. “I know it’s tuna, but it says. ‘Chicken of the Sea’”. Well, Jessica, we feel the same way about soy chicken. It says chicken, but it’s not. Try as we might, we’ve yet to meet a slice of soy chicken we enjoyed eating. In 2013, we’re sticking with tofu and calling it a year.

#5 Kale

You were more popular than Kate Upton in 2012. But, truth be told, you require more accessorizing than Kate Upton to be palatable. You need to be dressed and washed and sautéed and flavored – and gosh darnit, we’re tired. All this tastelessness just isn’t worth its sticker price. We hate to break the news like this, Kale, but you’re high maintenance. We’re taking back the keys. Really, it’s over. We’re shopping in the spinach aisle.

Anxiety Center Court

Wed, 02 Jan 2013 14:25:00 -0500

Fear is not a word we typically associate with a 6-foot-8 forward, weighing 270 pounds and boasting the widest hands – 11.5 inches (29.2 cm) – of any player in the NBA. But fear is what forced Royce White and his grandfather to drive cross-country for his college basketball games, when White was a player with Iowa State. And fear is what currently keeps Royce from playing basketball with his fellow teammates of the Houston Rockets.

Royce White was the No. 16 draft pick for the NBA. He hasn’t played with the Rockets since November 12, due to his dispute over the Rockets’ handling of his anxiety. White suffers from generalized anxiety and a specific fear of flying. He’s requested travel accommodations, as well as comprehensive therapy and greater leniency during practices, to help him return to the sport safely. Media channels have falsely narrowed White’s story to a refusal to travel. But his day-to-day battle with anxiety is a 24-hour rollercoaster ride: it occurs both on and off the court, when preparing for a game, when running sprints, or when recalling moments from his childhood:

“I’m never at 100 percent because my anxiety is going to take me down 25 percent before the game starts,” White says. “Before the game, I’m still feeling sick to my stomach because I want us to win so bad that my adrenaline is getting going before the game even starts. It’s hard to do it in front of 20,000 people. But I’ve trained my mind to deal with it.”

What makes White’s case unique, is that he’s been both outspoken and unapologetic about his anxiety. On Twitter, he calls his request for accommodations a “right” to have safe work conditions: “Asking for safe work conditions is a right, not a complaint!” He’s also started the hashtag #AnxietyTroopers to reference the universal battle that afflicts 18% of the U.S. population each year.

If White and The Rockets reach an agreement, White’s story will be aspirational: it will validate and uplift those whose apprehensions – both clinical and non – have placed them on the sidelines of their career. White is not the first NBA player to suffer from anxiety, but he’s the first to make a big stink about it – and for that, we’re cheering him on.

Happiness in 2013

Mon, 31 Dec 2012 11:32:00 -0500

We’re entering a new year, ripe with possibility. In honor of all that 2013 holds and promises to hold, we’ve assembled a guide to living more purposefully in the coming year.

Without further ado, the Meddik Guide to Happiness in 2013:

Step 1. Read What Challenges You

Take out a subscription – yes, a full magazine subscription – to a publication whose politics you don’t share. Let your mind roam free and you may be surprised by what you learn, even what you agree with. If you’re the novel reading type, try something outside your comfort zone. Replace science fiction with a romance novel.

Step 2. Make A Date With Strangers

We often say that meeting new people is one of the joys of living. Yet awkward silence with a stranger while riding the elevator is the norm. Make a coffee or lunch date with a stranger in 2013. If you need a little inspiration, just watch this video.

Step 3. If You Hate the Thought of Snow, Start Skiing

I have a friend with a strong distaste for snow. To be more accurate, he hates winter altogether, and its various “accouterments”, such as skiing. As with our advice on reading, the best way to expand your horizons is to try something that discomforts you. If this means getting on a pair of skiis for the very first time, take a deep breath and get out there.

Step 4. Appreciate Other Languages

Learning a new language has made many a new year’s resolution list, only to be forgotten weeks after January 1. Instead of promising proficiency, take in a language through more artful mediums, such as film, music or theatre.

Step 5. Seek Feedback or “Speed-back”

Most change happens in small increments. But you have to be in a growth mindset to appreciate change as it occurs. The V.P. of People Development at Google, Karen May, suggests trying something called “speed-back”. It works by placing people in fast-paced exercises and asking them to give feedback to each other, spur of the moment, based on their experience during an activity. For some, it is the best feedback – err, speed-back – they’ve ever received.

Step 6. Thank Someone Each Day

A rabbi I spoke with in September, during the Jewish New Year, advised me to say thank you more often. He said that “thank you” are the two most important words people can express to one another. “I love you” and “I’m sorry” are also good, but too often they’re overused. There is always something to be thankful for, and always someone whom is deserving of thanks. Seek out those people, and the opportunity to thank them.

Step 7. Rearrange Your Workspace Periodically

We tried this tactic at Meddik, and it livened our office with renewed vigor. Rearranging your workspace imbues the mind with creative energy. If you have not much space or furniture to rearrange, try adding a new piece of décor, refreshing flowers, or adding new desk pictures.

Step 8. Plan a Trip

You need not go far. (Truth be told, not everyone can afford an exotic vacation to Thailand). But if you save a little each week (Step 9), you can plan something meaningful for yourself. In making your itinerary, we suggest leaving time to enjoy each site you see (i.e., don’t over-book), and including adventurous day trips.

Step 9. Save for Something

Travel always tops our list, but saving for smaller budget items is a great way to reward yourself. The act of saving is an accomplishment in and of itself – so treat it as such. Make a ritual of adding to your savings account. Be thoughtful about how the money will benefit you in the future.

Step 10. 10@10

At Meddik, we refer to our morning meetings as 10@10. Ten minutes of work updates and conversation, punctuated by lively debate. This 10@10 should be reserved for the evening hours – and can be replaced with 10@11 or 10@12 if that suits you better. Take 10 minutes to reflect on your day. Record your thoughts, whether on paper or electronically, which adds a second layer of processing to the exercise. Then, put your thoughts away, allow your mind to relax, and enjoy a restful night’s sleep.

Betting on a Sugar Pill to Cure Your IBS

Wed, 19 Dec 2012 10:17:00 -0500

Ted Kaptchuk, an Associate Professor of Medicine at Harvard, is encouraging scientists to investigate the healing power of placebos. He believes that researchers have narrowly studied medications for years, struggling to bolster their effects, while few have attempted to increase the effect of placebos.

But why on earth would a medical researcher bet on the strength of a sugar pill, over years of hard fought scientific data on drug treatment?

Kaptchuk’s ideas first gain traction in the early 2000s in a study of patients with irritable bowel syndrome (IBS). It was one of the earliest trials to not only examine the placebo effect, but also compare a dose-dependent response. In other words, Kaptchuk was curious to see if patients showed different rates of improvement in response to two types of placebos. His hypothesis was correct: patients who received sham acupuncture for IBS, combined with extensive physician care (Placebo Group 3), responded better than patients who received sham acupuncture combined with limited physician care (Placebo Group 2). The amount of care received was directly correlated with improvement. Ten years later, in December 2010, Kaptchuk conducted a similar study, also in IBS patients, only this time he informed patients that they were going to receive placebo. The effect was the same: patients in the placebo group scored an average of 5.0 on a scale measuring global improvement, while patients in the no pill group (the control condition) scored a 3.9.

The placebo effect has been observed in medication trials for decades. It’s believed to result from actual neurochemical changes in the brain caused by the belief that medications make people feel better. A growing number of doctors are catching “placebo fever” – though an equal number of naysayers walk among them – and research institutions are throwing up laboratories wholly devoted to their study. At Harvard’s Program in Placebo Studies, doctors are using sham procedures – yes, fake surgeries – to fight disease and chronic pain. The bigger the treatment, the bigger the placebo effect, said one Harvard researcher on 60 minutes this past Sunday. But because the placebo effect bets on our expectations of how medications work, it relies on a heavy dosage of deception. Moreover, it could have no effect at all for patients who question the efficacy of medication to begin with. Teasing out who is most likely to respond, and what other conditions are required for that response, will require several, if not hundreds, of sham drug trials. Could patients be swayed by the power of nothing? We’ll just have to wait and see.

“I Wish Somebody Had Saw it Coming”

Mon, 17 Dec 2012 10:45:00 -0500

While residents of a bereaved Connecticut town face a new week, Americans across the country are grappling with the question of why horrific tragedies like Newtown occur in the first place. It’s a question that burns in our minds, as we mourn the loss of 26 lives, most of them children ages 6 and 7.

We can cite lax gun control laws as the reason mass murderers are given access to guns. But this does not explain the intent to kill, especially in a young teenager with no history of violent behavior. Unless we ban the sale of semi-automatic weapons altogether – an unlikely change for a country that espouses its right to bear arms – improved gun control would not prevent a shooting spree in which Adam Lanza used his mother’s legally registered weapons. The Justice Department has proposed enforcing stricter regulations on the sale of guns, including background checks to identify the mentally ill, but even this would not stop an individual without a history of treatment. If there is no paper trail documenting a troubled past, the Justice Department is inept. “Meaningful action” – President Obama’s not so subtle reference to gun control – is needed to prevent these tragedies from occurring. But it would be more meaningful to talk about what’s happening to our nation’s teenagers before they acquire a gun.

Newtown was the second mostly deadly mass murder on American soil. It bears the hallmark characteristics of all the school shooting sprees that have preceded it. The table below, compiled by staff at the New York Times [the age column at right is our own addition], describes the 11 most deadly shootings in American history. A few patterns are worth noticing: 1) 6 of the 12 gunmen were age 25 and younger; 2) all of the shooting sprees in that subset took place within a school environment, except Aurora, Colorado; 3) 5 of the 6 gunmen committed their acts within the last 13 years; 4) 6 of the 6 gunmen were white males; 5) 6 of the 6 gunmen had an untreated psychological illness. And let’s not forget the other examples: Thurston High School in 1998 (gunman Kipland Kinkel, Age 15; 29 killed and injured); Lake Senior High School in 2005 (gunman Jeffrey Weise, Age 16; 16 killed and injured).

If we learn anything from Newtown and its sister tragedies, it’s that meaningful action must occur before the point of purchase, or the illegal acquisition of a gun. We cannot turn a blind eye when children with mental illness slip under the radar. Gun control will reduce the presence of weapons, but it will also put a band-aid on a systemic health problem that festers among us. When asked about the motive behind the Newtown shooting, Marsha Lanza, aunt of Adam Lanza, was at a loss for an explanation: “I wish I had an answer for you,” she said, “I wish somebody had saw it coming.” After Newtown, we all need to talk about what we can do to see it coming, and prevent it.

Marijuana and Its Discontents

Fri, 14 Dec 2012 11:00:00 -0500

There are a host of prescription medications designed for pain management, but whether these medications provide relief is entirely dependent on individual response. In a 2007 town hall meeting, Mitt Romney said that he would not support the legalization of marijuana for medicinal purposes because “pain management is available from other sources”. Perhaps Romney never met six-year-old, Jayden David, a boy who suffers from violent seizures, and for whom bathing, eating and walking was an ordeal, until he began taking a liquid, nonpsychoactive form of marijuana.

(Select the image below to hear Jayden’s story.)

Pharmacotherapy has always been a process of trial and error. Minocycline, a commonly prescribed antibiotic, works like a cure-all drug for some patients, yet it’s no better than a sugar pill for others. Drugs used to retard cancer development are notoriously fickle, rapidly attacking cancerous cells for a period, and then, like a switch suddenly turned off, they stop working. If we accept as fact that, on the whole, medical marijuana is effective for pain management, with side effects no more dangerous than other analgesics, the question becomes not one of comparative treatment (e.g., is marijuana better than morphine?) but rather, who is most likely to benefit from medical cannabis? What is the clinical history of that patient?

For patients with an incurable condition, there is a personalized, concierge aspect to treatment that explains why some experience symptom reduction and some do not. Opponents of medical marijuana will argue that it’s under-researched, and that treatment from a young age puts children at risk for complications later in life. Though more studies are certainly welcome, we should remember that the risk-benefit ratio for patients like Jayden is fundamentally different than in the general population. For Jayden, medical marijuana is a life-giving drug.

The Culture of a Disease: Gluten Intolerance

Wed, 12 Dec 2012 11:21:00 -0500

For every identified Celiac patient (a person whose body cannot tolerate gluten, causing damage to the small intestine), there are 3-10 patients who have clinical histories consistent with Celiac Disease, but who fail to meet diagnostic criteria. Patients with non-celiac, gluten sensitivity (NCGS) can suffer for 10 or more years without a diagnosis. Because they cannot meet the basic “requirements” of the illness, their condition does not register on a doctor’s radar: it’s not present in lab tests, it’s not indicated in their family history. In a November issue of the British Medical Journal, a patient chronicles his struggle with NCGS.

Strangely enough, at a time when Celiac Disease awareness is increasing, underdiagnosis remains a problem. It raises an awkward question: Do physicians discount patient experience when it cannot be aligned with medical text? Moreover, what does it take for the cultural tides of an illness – how it’s described, how it’s diagnosed, how it’s treated – to change?

For centuries, the formulation of disease has been shaped by medical zeitgeist. Autism is currently understood to carry a strong genetic loading, but in the 1950s, that genetic link was viewed through an environmental lens – one of maternal deprivation – and so-called “refrigerator mothers” were blamed for raising autistic children.

In Celiac Disease, flare-ups indicative of gluten intolerance despite negative blood tests and biopsies, may be enough to frustrate and delude doctors. As one gastroenterologist put it, the underdiagnosis of Celiac Disease is led by an “irrational resistance” in the medical community to a widespread recommendation for gluten avoidance. Physicians acknowledge that many patients respond favorably to a gluten-free diet, even when they maintain that those who fail to meet diagnostic criteria should not be regulated to gluten-free eating.

Anecdotal evidence from patients – the kind that some gastroenetrologists are skeptical of – can lead to false conclusions about causation. As a general rule, the medical community only applies so much weight to case studies like the one in BMJ; these rarely form the basis for large-scale clinical trials. Nonetheless, the formulation of disease should include space for patient observation. As the culture of a disease evolves, we should remember that patient experience fits into a broader, more complex picture of illness.

Who’s Responsible for the Proper Disposal of Prescription Meds?

Mon, 10 Dec 2012 11:06:00 -0500

You wake up with excruciating shoulder pain and call your physician’s office. He prescribes a 30-day supply of the painkiller, codeine. The pain persists on a low dose, so he increases the strength to 30mg. But on a higher dosage, you experience terrible nausea and dizziness. Five prescriptions and 150 unused pills later, you’re still searching for a panacea. Are the unused pills safe in your medicine cabinet? Can they be tossed in the trash? Who’s responsible if they fall into the wrong hands?

Once a drug leaves the secure confines of a pharmacy, the burden of proper storage and disposal rests squarely on the shoulders of patients. Rates of prescription drug abuse are staggering, with nearly all drug poisonings resulting from an improperly used medication. Among teens, drugs are easily passed from patient to patient, a phenomenon that sustains the widespread abuse of ADHD medications in secondary schools. Of the 71,000 youth seen in the ER for a drug overdose each year, nearly half report that the abused substance was not their own to begin with: some pocketed it from a parent’s medicine cabinet, while a substantial number cannot trace its exact origins.

The rule of individual responsibility for drug disposal is faltering. California has taken notice. The state is now asking pharmaceutical companies to implement drug take-back programs, which would allow consumers to properly dispose of unused medications at a collection site. It’s a step in the right direction – if the legality of the proposal can be upheld against challenges from PhRMA. But drug return programs are only the tip of the iceberg. Physicians, pharmacists and public health officials must provide didactics on proper disposal, and teach patients that hoarding is not an innocuous practice. I cannot recall the last time I left a clinic or a pharmacy with specific instructions on how to dispose of my unused pills. Surely drug manuals – all 20,000+ words printed in 6 point font – must contain useful details on disposal. But then again, I typically toss the drug manual in the trash, along with my unused pills.

A Quantified Self for All

Fri, 07 Dec 2012 11:36:00 -0500

Each day, the gaming technology market is swarmed by a crowd of eager newcomers. New to join the party is SuperBetter, a mobile app that turns physical and emotional challenges into heroic battles against good and evil. SuperBetter is one of the latest iterations on quantified self technology.

Filled with alliances, preternatural powers, and epic conquests, SuperBetter promises to build your resiliency as you strive toward the ultimate title of becoming SuperBetter.

In the behavior change space, SuperBetter is joined by Lift, an app that facilitates good habit formation; Everest, an app that encourages goal progress and visualization; and Gratitude Journal, an app that refocuses attention on positive thoughts. All of them bear the hallmark of the quantified self movement - tracking - a concept that has become synonymous with self-improvement.

The origins of quantified self are sometimes traced to a 2007 story in Wired Magazine by editors Gary Wolf and Kevin Kelly. But other forms of tracking existed decades before.

In medicine, doctors and researchers commonly use ecological momentary assessment (EMA) to track symptoms and disease states over a period of time. EMA is a real-time assessment method that reduces memory bias, preventing a phenomenon in which patients struggle to accurately recall their symptom history. Using mobile technology, doctors and researchers can program EMA devices to capture variables that fluctuate – mood and arousal, for example – as well as discrete events, such as binge-eating episodes, or a foiled quit attempt in a smoking cessation study. The totality of all this data is a more refined, granular picture of illness or addiction.

Gaming applications that include tracking are really a variant on EMA technology. The anecdotal evidence in their favor is strong. In a review of Lift for Forbes, Lim Yung-Hui writes, “Accomplishing the intended action is your small personal victory…And one can actually extract a good dose of satisfaction when clicking on the innocuous [check-in] button.” The jury is still out on whether SuperBetter will achieve its loftier goals of healing illness and injury through the psychology of gaming. The health problems they intend to tackle are inherently more complex and diverse. But the tool is backed by a compelling team of scientists at leading research institutions. In the days of “there’s an app for that”, the quantified self movement now comes in many flavors.

Want to Improve Patient Safety? Educate the Bystander

Wed, 05 Dec 2012 15:01:00 -0500

If a tree falls in a forest and no one is around to hear it, does it make a sound? If a man is pushed onto subway tracks, but no one tries to save him, does it matter that he will die?

We don’t often use the Meddik blog to comment on local news, but on occasion there’s a human story that requires our response.

On Tuesday, a 58-year-old man died in New York City, when he was pushed onto the track of an oncoming subway train. Bystanders stood on the subway platform, watching in horror, as the man neared a certain death. In those moments of silence, no one attempted to save him, but a freelance photographer did snap the photograph below.

We are all familiar with the bystander effect: It’s the notion that responsibility diffuses among a group of people in emergency situations. The mere presence of other bystanders causes us to wrongly assume that someone else will act. Instead of assuming responsibility, we do nothing. The man who suffered a harrowing death on Tuesday was struck by a train, but it was the bystander effect that sealed his fate.

Instances of social culpability appear in all facets of life, but it’s only when the damage is so egregious that we take notice. In a recent article in Health Affairs, Jonathan Welch chronicled his fight to involve patients and families in a coordinated effort to reduce medical errors. What Jonathan Welch’s narrative may also reduce, is the impact of the bystander effect on patient safety.

Part of the problem with correcting medical errors is that too many patients feel they lack the knowledge or influence to make a change. Patient bystanders presume that others with more expertise or clout will speak on their behalf, and in the meantime, they are struck by inaction, helpless to pursue the proper recourse. The Jonathan Welch’s among us - Welch a physician himself - are few and far between. As hospitals strive to improve quality care, they’ll need to develop programs that teach patients what questions to ask, what avenues to pursue when dissatisfied with the quality of their care. If we want to put an end to the bystander effect, we need to educate the bystander.

The Razzle Dazzle Public Health Campaign

Tue, 04 Dec 2012 13:03:00 -0500

Dr. Ian Roberts wanted to draw public attention to tranexamic acid (TXA), a generic drug that could prevent tens of thousands of trauma patients from bleeding to death each year. Eschewing traditional forms of advertising, he appealed to doctors and patients through a medium normally reserved for superheroes and villains: the comic book.

Roberts believes that TXA can save the lives of critically injured patients by preventing blood clotting – if only doctors knew how to use it properly. “Science is very good at finding the answer to whether a treatment works,” Roberts tells Shots. “But it’s very bad at helping you to remember that that treatment is effective. What people remember are stories — emotional stories.”

Similarly, public health organizations use Chicago style, “razzle dazzle” campaigns to tell stories that will shock, awe, and inspire behavior. The best campaigns easily achieve virality, but it’s less clear whether they produce their intended effect in consumers. Do they help us quit smoking? Do they prevent the spread of infectious disease?

Below, we’ve gathered a smattering of the longest-lived and shortest-lived public health campaigns. Let’s see how they fared.

“Ransom Notes” by the NYU Child Study Center was designed to raise awareness of child mental and neurological disorders. The campaign was met with so much criticism that it ended in two short weeks. Some felt the ads reinforced the negative stereotypes they were meant to dismiss. But if the aim was to get people talking about children’s mental health, did it work?

“Love Life, Stop AIDS” has earned more shock value in its 25-year lifespan than most social marketing campaigns in history. It’s an example of one of the longest running, most carefully evaluated, and successful campaigns for AIDS prevention in the world. Between 1987 and 1990, condom use among men ages 17-30 years old, increased from 8% to almost 50%.

In June, the Lung Cancer Alliance covered telephone booths and bus terminals with posters boldly proclaiming that hipsters and cat lovers deserve to die. The aim was to alarm the public with a bizarrely-positioned reminder that lung cancer does not discriminate. Some felt the campaign sent a powerful message. Others found it confusing, offensive, and downright freaky: “No one understands it,” said a shop owner from New Orleans. “People ask us what the hell is it about. And we say we don’t know what the hell it is about.” The campaign is still active on the organization's website.

We’re curious to know: Do these campaigns spur you to action, or do they just ‘razzle dazzle’ you?

Do We Live in a Mammogram Economy?

Mon, 03 Dec 2012 10:51:39 -0500

When we are still toddlers, we hear the old medical adage on repeat: An apple a day keeps the doctor away. But patients may be surprised to learn that the ideology behind preventative care — early detection — does not always earn its stripes.

A study published in November in the New England Journal of Medicine found that mammograms do not reduce the number of breast cancers diagnosed at an advanced stage.

It is not the first study of its kind.

Trials examining prostate cancer screening have exposed repeat detection misses; cardiac stents have shown little benefit in stable patients; every year, a quiet storm builds around the flu vaccine, which scientists cannot design to protect people age 65+ — a story recently covered on our blog.

And the list goes on.

The tie that binds these procedures is their sticker price. High in cost, and low in effectiveness, preventative care has fed what Dr. David Newman calls a mammogram economy – a marketplace sustained by costly procedures despite their weak evidence base. “[I]nexplicably,” says Dr. Newman, “since the publication of these [mammogram] trial results…hundreds of millions of public dollars have been dedicated to ensuring mammogram access, and the test has become a war cry for cancer advocacy.”

As patients, we equate the word ‘screening’ with ‘early detection’. Public health announcements teach us that screening detects malignant cell growth, signaling to doctors when medical intervention is needed. It would be silly, unorthodox even, to question the benefits of early detection. And nowhere is public advocacy for screening stronger, or more robustly coordinated, than within breast cancer research and prevention. But what if these conclusions about preventative care are misguided? Might our health care system willfully ignore the limits of early detection? If we live in a mammogram economy, what should be done to fix it?

If Patient Bracelets Could Talk

Fri, 30 Nov 2012 11:31:00 -0500

Say you’re walking through a hospital unit and you step on a patient bracelet. It’s early in the morning, and you’re nervously anticipating surgery for an obscure heart arrhythmia. You’ve had the arrhythmia for as long as you can remember, but doctors can’t pinpoint what causes it, or find an effective treatment. You realize that the bracelet belongs to someone with the very same condition. Then, magically, it begins talking.

Now what?

If patient bracelets could talk, what would you hope to discover from a fellow sufferer? Last night, the Meddik team sat down to answer this very question. If you could peek at the wiring of an identical patient, revealing not just their previous medications, but a detailed account of the patient’s entire health ecosystem, what would you want to know? What questions would you have?

Here are a few things we came up with. Tell us what we’re missing in the discussion feed.

· Medical comorbidities

· Age and place of onset

· Diet and fitness regimen

· Events linked to flare ups

· Forms of treatment (e.g., alternative therapy, medication)

Personality Disorders on Trial: What Will DSM-V Mean for Patients?

Thu, 29 Nov 2012 11:06:11 -0500

Psychologists rarely agree on a singular definition of personality. At best, definitions of personality are slippery constructs. A classic example is the stark contrast between the character traits extroversion and introversion. Should they be considered distinct traits, or do they exist on a continuum?

Patients seeking treatment for personality disorders are frequently diagnosed with more than one illness, leading to the ambiguous “Not Otherwise Specified” diagnosis, a catchall label that, shockingly, is the most common personality disorder diagnosed today. Or, in some cases, two patients with the same diagnosis (e.g., obsessive compulsive personality disorder, a condition that is distinct from the anxiety disorder known as “OCD”) will not share any of the same diagnostic criteria.

Curious.

In a long anticipated effort, the Board of Trustees of the American Psychiatric Association will meet this weekend to vote on a proposal to adopt a new system for describing personality disorders. The new system is a dimensional trait model that reflects individual traits and behavioral patterns more flexibly, unlike the existing system, which is categorical and follows strict diagnostic criteria (e.g., Jane Doe must have 5 out of 9 symptoms to meet criteria for Narcissistic Personality Disorder). But because these proposals are so controversial, it’s likely that they’ll be thrown out, or otherwise relegated to an appendix in DSM-V.

What does all this mean for patients? A likely answer is not much. However, we can bet on two things: One, the labeling of personality will continue – and some would argue that labeling actually validates years of suffering for patients who’ve gone without a diagnosis; Secondly, we can bet that insurance companies will not cover sound treatments for personality disorders, so long as they continue to occupy Axis II. This is based on the misperception that these disorders are not treatable, unlike conditions on Axis I, including mood and anxiety disorders. Perhaps the American Psychiatric Association is better off using the weekend to lobby insurance companies for coverage of conditions on Axis II. That effort might prove more fruitful than engaging in a philosophical debate about disordered and ordered personality.

But, I digress: tell me again, is it possible for a person to be introverted and extraverted at the same time?

(Image above: A drawing by Jonathon Rosen for the New York Times.)

The Toughest Decision in Health Care

Wed, 28 Nov 2012 09:51:00 -0500

Medical technology has allowed us to prolong the lives of the terminally ill – but at what cost? In health care today, one of the toughest decisions medical professionals and families face is deciding when to end life-sustaining interventions.

For some families, the thought of “giving up” is so noxious that discussions about end-of-life planning are avoided altogether. Not only does this compromise the wellbeing of patients near death, but it also contributes to wasteful spending in the heath care system.

It is a problem that oncologists, who routinely treat the chronically ill, know all too well. When faced with a dying patient, one oncologist revealed that, “to avoid feeling that they’ve abandoned their patients, doctors throw procedures at them”. In fact, doctors who treat cancer patients often suffer from occupational distress, becoming agitated and frustrated by feelings of helplessness and failure. And yet if we commit families and medical professionals to the belief that comfort is the very best treatment near death, we can preserve precious moments with friends and loved ones, and avoid unnecessary, costly procedures.

In a recent guest post on e-patients.net, Susannah Fox discussed One Slide, a project by Engage with Grace to encourage families to begin conversations about end-of-life care. We appreciated Susannah’s honesty, as she grappled with questions about death and dying with honor. You can read her post here, and take the One Slide questionnaire below:

Our Need for Speed

Mon, 26 Nov 2012 12:20:00 -0500

When people think of the ideal consumer web experience, the words “speed” and “efficiency” come to mind. The extensive use of search engines has reduced online customer satisfaction to a very basic need for speed. A telling example of this was an experiment by Google in which people reported more happiness with the search function when the results were delivered a few milliseconds faster, at a rate below what the conscious mind can actually perceive. Since then, Google and Microsoft have spent billions on returning faster search results to impatient computer users.

Even beyond search engines themselves, speed appears to dominate the design of any website. In one study by HubSpot, 76% of consumers reported that the most important factor in a website design is “the website makes it easy for me to find what I want.” A mere 10% reported that they cared about the aesthetics.

In real world settings, the consumer experience takes on a very different tone. We value things like friendliness, the pleasantries of “hello” and “thank you”, a knowledgable staff, good listening skills, and a high quality product. The same rules apply when the product is health care. According to a 2006 study discussed by Kevin Pho, patients want their doctors to be “confident, empathetic, humane, personal, forthright, respectful and thorough.”

So what might explain our fascination with speed online? It may be that speed promotes a false sense of accomplishment; the faster we receive search results, the faster we presume we’re getting somewhere. But the Internet is notorious for creating attention-deficit computer users, and the frantic speed at which we navigate the web, often squanders our ability to weigh the merits of the content we’re reading. In an autocomplete-obsessed world, it may be time to consider the hazards of speed. If we come to believe that the durability of information is determined solely by the rate at which answers reach our fingertips, we may enter a universe in which people and authorship are forgotten.

Down and Out Duke

Wed, 21 Nov 2012 12:27:00 -0500

In what western film does John Wayne, otherwise known as “the Duke”, throw back a cold one and tell his riding buddy that he feels like less than a man?

If you’re scratching your head to answer this question, so are we.

Western film was the highest grossing movie genre of all time. That’s because John Wayne was a loud-mouthed, stubborn, indefatigable cowboy. We wouldn’t have paid Miramax a dime to watch a down and out duke moping across the old West.

Fun as Hollywood storytelling can be, a different narrative plays out when we’re not watching the big screen.

Six million men in the United States suffer from depression. Twenty-five percent of fathers experience post-partum depression 3 to 6 months after childbirth. Yet, only a sliver of these men will talk about their symptoms and seek help.

In a recent study, researchers asked participants to read a vignette describing a depressed man or woman. “Jack” and “Kate” suffered from textbook depressive symptoms including sadness, fatigue, withdrawal, and lack of interest:

“Kate/Jack feels pretty worthless and very discouraged. She/he isn’t enjoying things the way s/he normally would. In fact, nothing gives her/him pleasure.”

Did participants describe Jack as a down and out duke? Hardly. They were less likely to perceive Jack as suffering from a mental health disorder, and men in particular, insisted at higher rates than women, that Jack did not need help. However, they believed Miss Kate was a damsel in distress, suffering from a significant problem for which she needed expert advice.

Gender stereotyping is still a struggle in many facets of American life. But when it comes to mental health, we’re really dragging our feet. Until we start treating undiagnosed male depression as a cultural problem, we’ll still be fastened to the fantasies of the old west.

Revisiting the Default Network

Mon, 19 Nov 2012 16:30:00 -0500

When I was a research assistant in adolescent psychopathology at Columbia University, I sat in on the Grand Rounds for a scientist who was studying the default network in Alzheimer’s patients.

The default network is a hypothesis about brain functioning when the mind is at rest. It suggests that the creative outposts of the brain kick into high gear when we’re not focused on a specific task. When the brain is unhinged, your mind wanders, enabling you to free associate, create, and form new memories. If you’ve ever experienced a mental breakthrough while riding the New York City subway system, it’s likely that your default network was turned on.

The researcher who spoke at Columbia argued that the default network comes under attack in patients with neurodegenerative diseases. This occurs through buildup of a protein called beta-amyloid. Excess beta-amyloid hobbles the default network, impairing the brain’s ability to rest and recharge. The theory goes that if scientists find novel ways to stimulate the default network, the brain might naturally dispose of the excess protein.

Some two years later, the default network is under attack once again – this time by a new set of discoveries on the genetic causes of Alzheimer’s Disease. Scientists are finding that the brain suffers from significant deterioration well before the toxic buildup of beta-amyloid. In some cases, deterioration is visible up to 20 years before symptoms of dementia are detected by loved ones. If future studies replicate these findings, what does this mean for the default network?

Scientists are often faced with the challenge of reconciling the old with the new. As patients, we rely on scientists to draw wise conclusions about new findings, allowing discoveries to inform existing theories about the etiology of illness. For us at Meddik, the changing course of research in Alzheimer’s Disease is a humbling reminder that science, too, is a narrative. It will take decades, if not centuries, to get that narrative right.

(The images below are taken from The New York Times website. The first shows the brain scans of a member of a Colombian family who has Alzheimer’s Disease. The second shows members of the same clan).