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Archive for July, 2008

There’s an interesting and thought-provoking article in the BMJ last week about health promotion and a call to tackle the ageing process.

The traditional medical approach to ameliorating modern chronic diseases has been to tackle them individually, as if they were independent of one another. This approach flows naturally from our experience with acute diseases, where patients seek medical care for one condition at a time. In fact, applying this same strategy to infectious diseases in the 20th century helped to deliver the first longevity revolution.4 Although some infectious diseases have chronic effects on health (such as malaria and HIV infection), and others remain difficult to treat (including tuberculosis and most viral diseases), public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.

The phrase which really struck me here is the last one – “public health efforts to combat these diseases have made it possible for people in today’s developed nations to live long enough to experience one or more of the degenerative and neoplastic diseases that are now the dominant causes of morbidity and death.” Think about that for a moment. Yes, there have been great advances in human health and life-expectancy has increased dramatically (mainly due to the reduction in infant and child mortality), and, yes, the ability to effectively treat so many potentially fatal infections has played a significant role in improving human health. But what we have now is more people living long enough to experience a serious chronic disease. So what are we going to do about that? The authors argue this –

Medical research worldwide has already accomplished much, and is certain to achieve more in decades to come, but its effectiveness will become limited unless there is an increased shift to understanding how ageing affects health and vitality. Most medical research teams are oriented towards the analysis, prevention, or cure of single diseases, despite the fact that nearly all of the diseases and disorders experienced by middle aged and older people still show a near exponential increase in the final third of the life span. Now that comorbidity has become the rule rather than the exception, even if a “cure” was found for any of the major fatal diseases, it would have only a marginal effect on life expectancy and the overall length of healthy life

I would disagree a bit – in fact, I don’t think ageing is the issue, it’s health. I think we don’t so much need to understand how ageing affects health and vitality as to understand how health and vitality affect ageing! It’s true that so much of contemporary health care in focused on treating single diseases and disorders (in fact almost the entire evidence base of “evidence based medicine” is clinical trials conducted on individuals with single conditions), but it’s also true that “comorbidity has become the rule rather than the exception”. That’s such an important point to take on board. We will NOT have any significant further improvement on health and longevity by focusing on single conditions and diseases.

Instead, we need to focus on health and vitality. It’s well known that exercise and nutrition contribute enormously to both of these and some commentators on this article have made that point well.

What I take out of this article however is this – if we want to significantly improve health and longevity we need to focus on HEALTH not disease and we need to take the policy decisions to target health improvement if we are to reduce the burden of suffering and illness.

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clifftop clouds

This photo of a cliff with the clouds swirling around it looks distant and remote. You could imagine it’s a landscape in a wild, barely populated area.

However………

When I pull back the zoom without shifting my feet a single inch I can capture this photo……

cassis beach

Different impression entirely, huh?

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I posted about Randy Pausch twice before – once to post his Last Lecture video and once to tell one of the stories he told.

The inevitable death of Randy Pausch, the science professor who delivered a now-famous “last lecture” to students after being diagnosed with terminal cancer, was being mourned across America yesterday. A statement released on Friday confirmed that Pausch, 47, had passed away at his family home in Chesapeake, Virginia, ten months after his inspiring hour-long talk on “realising your childhood dreams” became a YouTube hit and publishing phenomenon. The cause of his death was metastasised pancreatic cancer, said a spokesman for Carnegie Mellon University. He had survived for more than twice as long as medical experts had predicted last year. Pausch became a global hero thanks to his farewell lecture, which was videoed. In a routine that saw him performing press-ups in front of a giant screen showing a CT scan of his tumour-ridden liver, he was said to have succeeded in teaching Americans how to live.

………..

Thank you Randy Pausch for your inspiration, your passion for life and for encouraging us all to dream.

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I read a report today by Professor Lipshutz about coenzymeQ10. I don’t know if you’ve heard about it but it’s a chemical which is necessary for the normal functioning of every cell of your body. Given its biological importance, some people have wondered if you can improve function, and therefore health, by giving additional amounts to people as some kind of supplement. The problem with the current supplements is two fold – first coenzymeQ10 has been expensive to make (that’s changed now as the Chinese have developed a cheaper method), and, second, there’s a problem of getting it absorbed into the body. The supplements on the market now tend to deliver only about 10 – 15% of the enzyme. The report I read today is from an American researcher who believes he has come up with a method to tackle this latter problem by using nanotechnology to make coenzymeQ10 easier to deliver effectively to the human body.

OK, so far, this sounds like a good story. If this stuff in needed and giving more of it makes people better then something that improves its availability must just be a good thing. But the question of whether or not taking supplements of coenzymeQ10 will improve your health, either in general, or specifically in relation to particular diseases, hasn’t been clearly answered yet. I agree with the logic expressed by Dr Langsjoen who wrote a very clear summary here. He said –

Modern medicine seems to be based on an “attack strategy”, a philosophy of treatment formed in response to the discovery of antibiotics and the development of surgical/anesthetic techniques. Disease is viewed as something that can be attacked selectively – with antibiotics, chemotherapy, or surgery – assuming no harm to the host. Even chronic illnesses, such as diabetes and hypertension, yield simple numbers which can be furiously assaulted with medications. Amidst the miracles and drama of 20th century medicine we may have forgotten the importance of host support, as if time borrowed with medications and surgery were restorative in and of itself. Yet, in this age, a patient may be cured of leukemia through multiple courses of chemotherapy and bone marrow transplantation, only to die slowly of unrecognized thiamine (vitamin B1) deficiency(47). Like the vitamins discovered in the early part of this century, CoQ10 is an essential element of food that can now be used medicinally to support the sick host in conditions where nutritional depletion and cellular dysfunction occur. Surely, the combination of disease attacking strategy and host supportive treatments would yield much better results in clinical medicine.

There was one particular phrase used by Professor Lipshutz which did alarm me however –

Nature gave us, through 2.5 billion years of evolution, a number of fundamental anti-aging, free-radical scavengers that helped us to survive, on average, only to about 40 years of age, until modern medicine came along

Dear, oh dear. Does Professor Lipshutz really believe that? That life expectancy has increased in the developed world from 40 to 70 years because of “modern medicine”? That’s just not true. And it’s not even what is taught in medical schools. The BIG improvements in life expectancy are not down to medicine at all. They are down to clean water, better housing, improvements in food availability and reductions in absolute and relative poverty. We won’t improve the health of most people by technical fixes. It’s going to need some political will to change our societies.

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There’s a good piece in the New York Times today by David Brooks. He’s discussing the issue of genetics and pointing out very clearly and sensibly that the early claims about the possibilities which genetic discoveries might bring to understanding human behaviour were way off. As he says, first of all, we’ve seen there is no simple single mapping of particular genes to particular behaviours. There is no aggression gene for example. Instead behaviours seem to be related to multiples of genes, with there being literally trillions of possible combinations of interaction between the genes within the gene sets. Secondly, he points out that it’s now clear that genes only express their potential in the presence of particular environmental factors. And thirdly there is a total lack of clarity about the terms we use to describe our inner experiences. How do you know that what you can anxiety is what I’d call anxiety?

In conclusion, I think that what he highlights is that reality is messy and complex and those who are still enmeshed in the old logical positivist scientism just haven’t caught up!

Our lives are not determined by uniform processes. Instead, human behavior is complex, nonlinear and unpredictable. The Brave New World is far away. Novels and history can still produce insights into human behavior that science can’t match.

We can strive to eliminate that multivariate thing we call poverty. We can take people out of environments that (somehow) produce bad outcomes and try to immerse them into environments that (somehow) produce better ones. But we’re not close to understanding how A leads to B, and probably never will be.

This age of tremendous scientific achievement has underlined an ancient philosophic truth — that there are severe limits to what we know and can know

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I wandered into the Cathedrale Saint-Saveur in Aix en Provence the other day. It’s one of those awe-inspiring spaces. In fact, it’s a multiple of spaces inside, some vast, and some small and intimate. I’m always interested in the way plants are used by human beings (enthobotany is the correct term!) and so it was no surprise to see the prominence of lilies in the cathedral.

lilies in the church

Lilies are one of those plants which have special spiritual signifance over many centuries. If you ever wander around a gallery of French or Italian paintings for example, you’ll spot lily plants in many of the religious ones. The white lily is sometimes referred to as the “Madonna Lily” which further conveys the extent to which people have imbued this plant with spiritual significance.

The scent of lilies is very, very strong. I find it quite overpowering. In fact, it doesn’t take long before I feel rather queasy in a room full of lilies. It’s a pity for me because I think they are very beautiful but I can’t have them in my house. Fortunately, the cathedral is so large I could escape the scent of the lilies pretty easily.

What did surround me absolutely everywhere was the music. They were playing Thais’ Meditation. You know it? Here’s Sophie-Anne Mutter playing it. It’s one of those pieces of music that always, but always, makes me feel tearful. It moves me in my core.

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morning moon

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