It’s my first trip to London, or to the UK for that matter.  The city itself has the distinctive, quintessential, old-world charm I pictured, yet it’s blanketed with the expected conveniences of modern technology.  My office for the past two days has rotated between a few wifi-enabled local pubs, a scene that may in fact be the clearest example of the integration of the old and the new.

Some simple trip stats thus far:  Days in London: two.  Number of times I’ve ordered fish and chips as a meal: two.  Number of close calls I’ve had with speeding cars after looking in the wrong direction while crossing the street: four (This is in spite of the clearly marked ‘Look Left’ or ‘Look Right’ warnings pasted in the crosswalk).

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It’s 6am and my alarm clock is buzzing, but I don’t hear it. I don’t even move. But the incessant noise wakes my wife, and her gentle nudges (read: elbows) and soft whispers (read: expletives) eventually convince me to get out of bed. Read more…

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My inbox flooded with links to the report released by NIH (and evangelized by TIME) stating that lifestyle interventions (diet, physical activity, mental exercises, etc.) may not be that effective in preventing Alzheimer’s Disease.

Before I mount my full counterattack, I need to carefully read through the studies the meta-analysis cites.  Still, a quick glance at the exclusion criteria of the meta-analysis reveals the authors limited their review to studies using patients over the age of fifty.  So really, these results imply that lifestyle modifications may not prevent, delay, or treat Alzheimer’s Disease if you start these changes later in life.

My second point is that all lifestyle modifications are not created equal.  Scientific evidence in animal studies suggests that of all interventions, aerobic exercise is our best chance of staving off cognitive decline.  In fact, this meta-analysis also found some correlation between exercise and preserving or improving cognitive ability.

There’s a good article in The Economist that discusses the failures of the drug industry to find a solution to treating Alzheimer’s Disease.  One particular quote resonates with my feelings on the NIH report:

Another fundamental problem is that, whatever is causing the damage, treatment is starting too late. By the time someone presents behavioural symptoms, such as forgetfulness, his brain is already in a significant state of disrepair. Even a “cure” is unlikely to restore lost function.

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We’ve all heard the mantra: keep LDL levels – the “bad” cholesterol – down, and the “good” HDL cholesterol up. But thanks in part to the ubiquity of statins, such as Lipitor, which allow us to simply pop a pill to limit LDL production in the body, we’ve recently adopted tunnel vision when thinking about managing cholesterol. LDL levels are all we seem to care about now, as we strive for lower and lower numbers at each visit to the doctor’s office.

However, I think we’re missing the bigger picture by focusing solely on LDL. First, it’s made us reliant on medication to solve a problem that can many times be addressed with changes in diet and exercise regimes. Once someone starts Lipitor treatment, they’ll be taking it for life, and if LDL levels don’t quite get as low as they should, it’s all too easy to solve the problem by increasing the dose. When patients first begin Lipitor treatment, physicians typically prescribe the lowest possible amount, 10mg. However, dosing can go as high as 80mg, which begs the question: Do higher doses of the drug really improve outcomes?

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I just finished reading Dave Dobbs’ new article in the the December issue of The Atlantic, “The Science of Success”.  Dobbs turns the classic question of Nature vs. Nurture, whether our genes or our environment are the deterministic drivers of our fate, on its head.  Traditionally, those who support “nature” say that our genes are most influential in defining us.  On the other hand, those that support the “nurture” side say that our environment plays a more important role.

Based on new research, Dobbs introduces the idea of two types of people, “dandelions” and “orchids”.  Dandelions can thrive anywhere, despite their environment or upbringing.  Orchids, however, are more temperamental, and require a stable environment to survive.  At first glance, the orchids may seem like a liability, and in fact, they often carry genes that make them susceptible to mood disorders and psychological disease.  The astounding part of Dobbs’ report is that he shows that given the right care, or environment, the orchids don’t just do OK, but far surpass the dandelions in perfomance.  In other words, given the right training, orchids may in fact be destined for greatness.

This finding redefines conditions we typically may have classified as undesirable.  ADHD, depression, and generalized anxiety disorder, are no longer conditions to dread, because given the right training, people with these predispositions may in fact be the true “movers and shakers” in the world.

Please read the full article for yourself.  And, as always, I’d welcome a discussion here…

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While attending the Institute for the Future’s Health Horizons Fall Conference on Monday, one thing became eminently clear. The 21st century will be the era of brain, the last great scientific frontier. Due to societal shifts, environmental changes, and the fact that we are just living longer, we are poised to see a sharp rise in cases of diseases such as Alzheimer’s, Parkinson’s, autism, and post-traumatic stress disorder. The only thing worse than the increasing prevalence of brain disease is the sobering fact that few viable treatments currently exist.

For years, we’ve heard the mantra of behavior change and health. Exercise more and you’ll cut your risk for heart disease and stroke. Eat more fruits and vegetables and you can decrease your risk for colon cancer (or possibly prostate cancer, as discussed in a previous Decision Tree post, “Why Behavior Change is Better Medicine than Drugs”). Could behavior change serve our brain health as well as it did other organs of the body?

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A few months ago, a story ran in Wired Magazine that described a noticeable shift in the scientific method, and attributed the change to our ability to produce and store large amounts of data.
Historically, the scientific method was built around a testable theory.  But in the 21st century, theories were becoming obsolete; the data simply spoke for itself.

Data from our bodies is no exception — physiologic data can now be accessed as a real-time data stream thanks to personal health monitors. But does the vast amount of data we get from our bodies make us any healthier? Do we need to collect data 24-hours a day in order to learn something interesting about our health? Is it even feasible to wear these sensors all day, every day?

I am embarking on a new self-tracking experiment to answer these questions (and possibly a few others). For 30 days, I will be using devices such as the Zeo personal sleep coach, the Philips DirectLife activity monitor, the Mio Motiva wristband on-demand heart rate monitor, and the Nike+ sportband. The goal of this study is not to pit one device against another; rather, I want to focus on what the data tells me, and how I can best use it to stay healthy.

I’ll get a blog post up here at least once a week, all the while working on a longer story about the journey that will be released at the end of the month.

Stay tuned. It should be a fun ride…

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I just wanted to offer a rebuttal to the following tweet that popped up on my stream today:

@GuyKawasaki The reward system actually reduces motivation http://om.ly/MHzl

First, let’s take a look at the cited study.  The experimental groups were defined as:

The children were then randomly assigned to one of the following conditions:

1. Expected reward. In this condition children were told they would get a certificate with a gold seal and ribbon if they took part.
2. Surprise reward. In this condition children would receive the same reward as above but, crucially, weren’t told about it until after the drawing activity was finished.
3. No reward. Children in this condition expected no reward, and didn’t receive one.

While reading this study, we have to ask ourselves: Is a “certificate with a gold seal” really a reward?  Is that what best motivates children?  Do the results of this study conclude that children don’t change their behaviors for rewards, or simply that the reward itself was lame?

Despite what the authors state, small rewards CAN be a powerful impetus for behavior change.  Reward is a staple of behavioral training, and in particular, rewards that release dopamine (e.g. food, sweet beverages, etc.) strongly influence brain plasticity during a training event.  To make a blanket statement on the contrary is dangerous.  Preventable disease is a huge drain on our health care system, and it’s been shown that simple behavior changes like diet and exercise can reduce the burden caused by obesity, diabetes, and heart disease.  Just because a child responds in a certain way to a reward of a certificate with a gold star, I don’t think we should abandon the proverbial “carrot” when trying to get people healthy.

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from: well.blogs.nytimes.com

The afternoon of Day 1 of the Health 2.0 Conference was highlighted by the session, “The Patient is In”.  First up, a video that documented the experiences of a group of people that recently started using patient health tools, such as online health journals that track diet or exercise, support sites for quitting smoking, or home blood test kits.

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Self-tracking is an effective way to change behaviors. That’s the result of a study conducted last year by the Kaiser Permanente Center for Health Research.

“The more food records people kept, the more weight they lost,” says Jack Hollis PhD, a researcher at KPCHR and lead author of the study published in the August issue of the American Journal of Preventive Medicine. “Those who kept daily food records lost twice as much weight as those who kept no records. It seems that the simple act of writing down what you eat encourages people to consume fewer calories.

“Every day I hear patients say they can’t lose weight. This study shows that most people can lose weight if they have the right tools and support,” says Keith Bachman, MD, a Kaiser Permanente internist and weight management specialist. “Keeping a food diary doesn’t have to be a formal thing. Just the act of scribbling down what you eat on a Post-It note, sending yourself e-mails tallying each meal, or sending yourself a text message will suffice. It’s the process of reflecting on what we eat that helps us become aware of our habits, and hopefully change our behavior.”

The study concluded what proponents of self-tracking have known all along, namely, that monitoring your own actions creates a heightened self-awareness. Sure, fancy new iPhone apps where you track your weight or blood-sugar over time are cool, but self-tracking doesn’t have to go hand-in-hand with technology.

Case in point, on my last visit to my mother’s place, I found a home blood pressure monitor and a piece of paper with scribbled numbers on it sitting on a table in the living room. She told me that she has been tracking her blood pressure every day for the past months, and writing the numbers in her notebook log. I had been tracking my running data for years using elaborate web programs, and complicated sensors. But suddenly I realized that self-tracking doesn’t have to be limited to the tech savvy or early adopters; a pen and a piece of paper will do the trick.

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