1.
Featured
Article: Unlocking the Secrets of Longevity Genes
Unlocking the
Secrets of Longevity Genes, By David A.
Sinclair and Lenny Guarente, Scientific American
A handful of genes
that control the body's defenses during hard times can also dramatically
improve health and prolong life in diverse organisms. Understanding how they
work may reveal the keys to extending human life span while banishing diseases
of old age
You can assume
quite a bit about the state of a used car just from its mileage and model year.
The wear and tear of heavy driving and the passage of time will have taken an
inevitable toll. The same appears to be true of aging in people, but the
analogy is flawed because of a crucial difference between inanimate machines
and living creatures: deterioration is not inexorable in biological systems,
which can respond to their environments and use their own energy to defend and
repair themselves.
At one time, scientists believed aging to be not just
deterioration but an active continuation of an organism's genetically
programmed development. Once an individual achieved maturity, "aging
genes" began to direct its progress toward the grave. This idea has been discredited,
and conventional wisdom now holds that aging really is just wearing out over
time because the body's normal maintenance and repair mechanisms simply wane. .
. .
Yet we and other
researchers have found that a family of genes involved in an organism's ability
to withstand a stressful environment, such as excessive heat or scarcity of
food or water, have the power to keep its natural defense and repair activities
going strong regardless of age. By optimizing the body's functioning for
survival, these genes maximize the individual's chances of getting through the
crisis. And if they remain activated long enough, they can also dramatically
enhance the organism's health and extend its life span. In essence, they
represent the opposite of aging genes--longevity genes. To read more, please go to www.medicaltuesday.net/feature.asp.
We began investigating this idea nearly 15 years ago by imagining
that evolution would have favored a universal regulatory system to coordinate
this well-known response to environmental stress. If we could identify the gene
or genes that serve as its master controllers and thereby act as master
regulators of an organism's life span, these natural defense mechanisms might
be turned into weapons against the diseases and decline that are now apparently
synonymous with human aging.
Many recently discovered genes, known by such cryptic names as daf-2,
pit-1, amp-1, clk-1 and p66Shc, have been found to affect stress
resistance and life span in laboratory organisms, suggesting that they could be
part of a fundamental mechanism for surviving adversity. But our own two
laboratories have focused on a gene called SIR2, variants of which are
present in all organisms studied so far, from yeast to humans. Extra copies of
the gene increase longevity in creatures as diverse as yeast, roundworms and
fruit flies, and we are working to determine whether it does the same for
larger animals, such as mice.
As one of the
first longevity genes to have been identified, SIR2 is the best
characterized, so we will focus here on its workings. They illustrate how a
genetically regulated survival mechanism can extend life and improve health,
and growing evidence suggests that SIR2 may be the key regulator
of that mechanism.
Silence Is Golden
We first discovered that SIR2 is a longevity gene by asking what causes
individual baker's yeast cells to grow old and whether a single gene might
control aging in this simple organism. The notion that an understanding of
yeast life span would tell us anything about human aging was deemed
preposterous by many. Aging in yeast is measured by counting how many times
mother cells divide to produce daughters before dying. A typical yeast cell's
life span is about 20 divisions.
One of us (Guarente) began by screening yeast colonies for
unusually long-lived cells in the hope of finding genes responsible for their
longevity. This screen yielded a single mutation in a gene called SIR4,
which encodes part of a complex of proteins containing the Sir2 enzyme. The
mutation in SIR4 caused the Sir2 protein to gather at the most highly
repetitive region of the yeast genome, a stretch containing the genes that
encode the protein factories of the cell, known as ribosomal DNA (rDNA). More
than 100 of these rDNA repeats exist in the average yeast cell's genome, and
they are difficult to maintain in a stable state. Repetitive sequences are
prone to "recombining" with one another, a process that in humans can
lead to numerous illnesses, such as cancer and Huntington's disease. Our yeast
findings suggested that aging in mother cells was caused by some form of rDNA
instability that was mitigated by the Sir proteins.
To read pages 2-5, (subscription required) go to
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2. In the News: And so to bed, by Lucy Atkins,
There are many health
benefits for those who enjoy regular sex. Lucy Atkins looks at the latest
scientific research.
It
does not take a degree in medicine to work out that sex is good for you.
Anything that is free, feels fabulous and leaves you glowing is plainly a good
idea. But scientists are now beginning to understand that the perceived
feel-good effects of sexual intercourse are merely the tip of the iceberg. Sex,
they are discovering, can help protect you from depression, colds, heart
disease and even cancer. To read more, please go to www.medicaltuesday.net/news.asp.
The
latest addition to the body of evidence came last month when Professor Stuart
Brody of the
To
see these benefits, you have to go the whole heterosexual hog. According to
Professor Brody, studies show that "penile-vaginal intercourse is the only
sexual behaviour consistently associated with better psychological and
physiological health".
Such
sex has been linked, in women, to a heightened emotional awareness, possibly
because of the "love-hormone" oxytocin that is released. One study
even found that semen is a mood-enhancing ingredient.
Doctors
speculate that this is because semen contains several other mood-altering hormones
- including testosterone, oestrogen, prolactin and several different
prostaglandins - which can pass into the woman's bloodstream. This explanation,
says Dr David Hicks, sexology specialist and consultant in GU medicine at the
The
health benefits for middle-aged men are also particularly persuasive. Recent
studies suggest that men who have orgasms twice a week are half as likely to
die early as men who orgasm less than once a month. The more frequently men
ejaculate, the less likely they are to develop prostate cancer, and if
middle-aged men have sex twice a week or more they also have a lower risk of
heart attack.
Much
has been made of the slimming and toning effects of a sexual work-out. In fact,
sex probably burns off about the same number of calories per minute as a brisk
walk. "You get all the benefits of exercise," confirms Dr Hicks.
"This includes the release of endorphins, raised heart rate, moving the
muscles and joints. One study even showed that arthritis can be delayed by
regular sex."
You
might also look younger. "Regular sex makes you feel younger as you are
more relaxed, satisfied and less stressed," says Dr Kevan Wylie,
consultant andrologist at the
"Sex
has huge mental benefits," adds Dr Hicks: "It's the outward proof
that you are wanted, desired and valued." And if you feel sexy, you tend
to look it, too.
Sex
is not, sadly, a cure all. "There is a danger in thinking that we can fix
anything by leaping into bed," says Dr Petra Boynton, a psychologist at
Sex could make you...
· Calm: up to a week after intercourse
your blood pressure remains lower, helping you to cope with stressful
situations.
· Happy: semen could have antidepressant
qualities and hormones released during sex include oxytocin, which promotes
loving feelings, as well as endorphins, the "feel-good" hormones.
· Healthy: regular sex raises your
levels of a cold-fighting antibody. It might protect men against prostate
cancer and heart disease.
· Youthful: sex increases longevity,
might improve skin tone, and gives you a glow.
· Serene: touch, which one sexuality
specialist calls "vitamin T", has been shown to reduce stress. Deep
breathing, as any yoga fanatic will confirm, also reduces stress, and profound
post-coital relaxation can certainly improve your sleep quality.
· Pain free: sex has been shown to
relieve some of the symptoms of PMT, arthritis and, yes, headaches because of
the release of endorphins - nature's opiates.
· Grounded: intercourse, ideally with
the same partner, creates an emotional and physical bond that is a vital part
of the social support we all need in order to feel truly happy.
To
read the entire article, please go to www.telegraph.co.uk/global/main.jhtml?view=DETAILS&grid=P8&xml=/global/2006/04/24/hsex22.xml.
* * * * *
3. International
Medicine: From the
Hospital consultants opt for private
cover By Peter Pallot
Four
in 10 hospital consultants in
All
those questioned worked in the private sector and 91 per cent also held NHS
posts. One reason for having the option of private treatment was privacy - they
did not want to be in a bed adjacent to one of their patients.
Other
motives included speedy treatment, fears about prevalence of the MRSA superbug
in state hospitals and better food and comforts in private units.
The
10 occupations most likely to take out insurance, according to the survey, by
Silver Fern Research, were, in alphabetical order: accountant, armed forces,
civil service, doctors, IT analysts, police, secretaries, the self-employed
(consultants, plumbers, electricians etc), solicitors and teachers.
Some
of these will be taking advantage of new cut-rate cover identified as likely to
boost the total number of individual policyholders by 10 per cent over four
years. To
read more about the UK's NHS, please go to www.medicaltuesday.net/intlnews.asp.
Market
analysts Datamonitor forecast 1.2 m privately insured people by 2010 because of
"sophisticated offerings that cost the consumer less but in return for a
lower premium, offer a lower level of cover".
www.telegraph.co.uk/global/main.jhtml?view=DETAILS&grid=&xml=/global/2006/04/18/health7.xml
_______________________
Why dentists are rapidly
disappearing from the NHS By Peter Pallot
Expatriates
who revisit
Like
the tree pipit and the spotted flycatcher, state dentists in
A
total of 2,100 practitioners said the new state contract had forced them to
offer private care only. More resignations from NHS practice are widely
predicted. Not only are NHS dentists virtually impossible to find in the South
East, but the private option comes at around three times the cost of the new
NHS tariff.
High
prices are pushing western Europeans to look east. Dentists in
Going
abroad for dentistry is not always going to be trouble-free. Follow-up care,
when your dentist is 1,000 miles away and speaks a different language, is
fraught with problems. Top-range international medical insurance plans can
certainly help, but insurers are not mugs and benefits are as capped as the
average octogenarian's molars. Most providers cover "emergency"
dental care on their top plans. The volume of claims here, though, is going to
be much less significant than the "routine" £500 crown or £100 root
canal treatment that hits many of the middle aged.
Among
leading providers, Bupa International is unusual in not covering any routine
dentistry on any of its individual plans. However, Bupa's Gold plan gives
emergency and accidental dental treatment cover to individuals up to £400 per
person per policyholder year.
PPP
International adopts a 50 per cent co-pay approach on routine dentistry, in
common with several providers - insurer and insured split the cost. PPP's top
Prestige plan pays half of fees up to £600 for those with worldwide cover; up
to £500 for worldwide cover except
To
read the entire article, please go to www.telegraph.co.uk/global/main.jhtml?view=DETAILS&grid=&xml=/global/2006/04/18/health4.xml.
_______________________
Feeling the bite of 2004 crackdown By Peter Pallot
Even
if British expatriates can find an NHS dentist willing to treat them on return home,
they could still fall foul of legislation. A Government crackdown of April 2004
was aimed at making the NHS "a service for British people who live in
The
Department of Health confirmed that the new strictures apply to dentists as
well as to hospital and GP services. It would be illogical if they did not,
since NHS dentistry is seen as less well-funded than its medical counterpart.
Under
the changes, EU-based Britons who spend less than six months a year in
Action against health
tourism was not primarily aimed at Britons who might have paid National
Insurance contributions and other taxes all their lives. They were caught by
policies aimed at dealing with reported abuses by immigrants who had no
connection with
www.telegraph.co.uk/global/main.jhtml?view=DETAILS&grid=&xml=/global/2006/04/18/health3.xml
_______________________
On
* * * * *
4. Medicare: The
2006 Trustee's Annual Report: Medicare Overview
Dr John Goodman of the
If you still suffer from the illusion that the
government is a responsible fiscal organization, be sure to read the report and
the unfunded liability of Medicare Part A, Part B, Part D. Also review how,
with Social Security, we are obligating our children and grandchildren with a
tax liability that will take nearly all of their tax money to pay for our
entitlements. Are we really entitled to enslave our own children and
grandchildren? How can we live with this unethical behavior? Read the report at
www.ncpa.org/pub/special/pdf/20060501_briefing.pdf.
Government
is not the solution to our problems, government is the problem.
- Ronald Reagan
* * * * *
5.
Medical
Gluttony: I Don't Care If It's of No Help, I Want to Know What I'm Allergic to
When I was an intern, a medical resident was
explaining to the Chief of Medicine why she had ordered an expensive test.
Would it help the patient? Would it change the management of the patient's
disease? When she answered no to all the questions, the Professor asked,
"Then why did you order it?" To which the resident replied, "I
just wanted to know."
Last week, I had a patient who developed a rash from
the lotions and sunscreens she used on her hands and arms when she went bike
riding on the weekends. Typically they would go away by Tuesday. However, she
had one lotion and one sunscreen that she could use comfortably. She kept a
year's supply of these in her medicine cabinet. She worried about what she
would do if that manufacturer went out of business. To read more, please go to www.medicaltuesday.net/gluttony.asp.
She wanted an allergy consultation to test the dozens
of lotions and sunscreens for their allergic potential to her skin in order to
find out what specific ingredient caused her allergy.
My reasoning failed to convince her that this would
not be clinically possible, and even research testing would not prove helpful
since she already had checked all the ingredients and found such a variety that
the process of elimination would not be productive.
Since she was so adamant, I knew that she would hail
the anger on me of her HMO, her managed care organization, her health insurance
carrier, and the state department of health and tie my staff up for dozens of
hours if not weeks. So I called an allergist and explained the situation. He
was kind enough to speak with her immediately and slowly she became convinced.
After he hung up, she stated that he obviously agreed with me and she was
satisfied and would not pursue this further.
Medical Truth: The Most Expensive Phrase in the
Medical Lexicon: I Just Want to Know
* * * * *
6. Medical Myths:
Modern Medicine Is An Imposing Edifice
To read the truth, please go to www.medicaltuesday.net/myths.asp.
Medical Truth: The whole imposing edifice of modern
medicine is like the celebrated
-Charles, Prince of Whales
* * * * *
7. Overheard in
the Medical Staff Lounge: Driving Is No Longer a Rite Of Passage at Age 16
Many physicians are restricting their high school
juniors and seniors from driving, except to school and related activities. Many
are restricting their 16 and 17 year olds from driving at night or later than c at http://online.wsj.com/article_print/SB114609575799637052.html. Actually, it's parental responsibility in trying to
avoid teenage deaths and the market forces of insurance that are more effective
than new laws. However, it wouldn't be a bad idea that one should be 18 to
drive on the Federal Highway System after dark. To listen in on more newspaper
talk with doctors, please go to www.medicaltuesday.net/lounge.asp.
_______________________
Politics In Education Is Also Corrupting
Dan Walters, the Bee's
Capital Reporter, observes, "The most fundamental rule of politics is that
perception is more important than reality - which explains why politicians
seemingly devote more time to polishing their images than doing their
jobs." "Perhaps the most interesting
current example of how perceptions drive politics, however, is the pickle in
which the venerable
He reports on an audit of
our own
_______________________
Since
politics is incapable of objectivity or reality thinking and works primarily
with public perceptions as Walters observes, it is important that health care,
which is being bandied about on everyone's personal perceptions unrelated to
reality, is never under the control of politicians. Americans are slowly
learning the same lessons in education and many are biting the bullet to send
the next generation of Americans to be schooled in private or parochial schools
rather than in the politically controlled failing public education system. The
future of our country depends on it.
* * * * *
8. Voices of Medicine:
A Review of Local and Regional Medical Journals
Physician Assisted
Suicide: Keep Physicians Out of It by Stan K. Sujka, MD, FACS,
When
in a 6-3 decision the Supreme Court upheld assisted suicide, David Savage of
the Los Angeles Times stated that it was "a victory for states and their
independent-minded voters, and a defeat for social conservatives." In my
opinion it was also a great defeat for doctors because it puts physicians in
the middle of this no-win situation.
In his book "Man's Search for Meaning," Victor Frankl, stresses man's
freedom to transcend suffering and find a meaning to his life no matter of his
circumstances. Frankl who during World War II survived Auschwitz, Dachau, and
other concentration camps, contended that suicide is never a rational response
to pain, whether in the sanitarium or in Auschwitz. Until his death in 1997,
Frankl spoke out consistently that "A man's life retains its meaning up to
the last - until he draws his last breath. The doctor must always act as an
agent of the sick man's will to live and as a supporter of his right to
live." Frankl understood that we have a duty and take an oath to preserve
life. Frankl said: "This duty remains binding, even when he confronts a
patient who has tried to destroy himself and whose life now hangs by a
thread." To read more, please go to www.medicaltuesday.net/voicesofmedicine.asp.
Historically, ethical traditions of medicine strongly opposes to the taking of
a life. The Hippocratic oath states, "I will not administer poison to
anyone where asked," and "Be of benefit, or at least do no
harm." Even when physician assisted suicide was not legal, survey of
physicians in practice showed that about one in five received a request for
physician assisted suicide in their career. Somewhere between 5-20 percent of
these requests are believed to be honored.
For those of you who are still applauding the Supreme Court's ruling, think
about the potential of abuse that exists here. Burdened family members and
health care providers may encourage assisted suicide. Picture it, the ultimate
cost-containment strategy! And if you still have doubts that it can happen in
this country, just consider the eugenics program. Started in
I don't debate a right to commit suicide. I simply object as a doctor being
involved in the process even in name only. We should take the
"doctor" out of the assisted suicide equation. Why do you need a
doctor to kill yourself? Why demand your doctor put him or herself in an
ethical dilemma? Just shut the garage door tight, keep the car running and
enjoy the ride; but keep doctors in the office and hospitals helping people who
want to live.
www.fmaonline.org/pubs/quarterly/april06_middle.asp
* * * * *
9. Book Review: Healthy
Competition - What's Holding Back Health Care and How to Free It by Michael Cannon & Michael D Tanner, Cato Institute, Part III: Chapter 8 - Medical Malpractice Reform.
Tort
law is an important protection against those who do or would injure us, yet
many complainwith some reasonthat the medical liability ''system'' in the . . . To read more, please go to
www.medicaltuesday.net/bookreviews.asp.
President George W. Bush has proposed federal
legislation to limit medical malpractice awards. However, the U.S. Constitution
does not grant Congress the authority to impose substantive rules of tort law
on the states. While the federal government may enact technical
procedural changes, state legislatures are the proper venue for correcting
excesses in state civil justice systems. The fact that medical professionals
can avoid states with inhospitable civil justice systems gives them significant
leverage when advocating state-level medical liability reforms, and gives
states incentives to enact such reforms.
That some states have done so further demonstrates that federal
legislation is unnecessary. Michael Greve of the American Enterprise Institute
notes, ''At least so long as state law is trending in an antiliability
direction, experimentation is quite probably preferable to a federal 'reform'
that might get it wrong, rob the reform states of their just rewards, and
discourage laggard states from experimenting with their own, possibly more
effective reforms.''
What reforms might states consider? Arbitrary caps
on damages may reduce the costs of frivolous lawsuits, but they foreclose
adequate relief in extreme cases, and prevent patients from bargaining for
greater protection. A ''loser pays'' rule often would reallocate the costs of
frivolous lawsuits to the correct party. However, it also would deter less
affluent patients from seeking legal redress for legitimate grievances. One
study found that ''abolishing joint and several liability, restricting
attorney's fees, and establishing victims' compensation funds all lead to fewer
physicians per capita'' within a state. Moreover, it is possible that arbitrary
limits on liability will diminish incentives for marginal providers to exercise
due care. The study also found that reducing awards to victims who also collect
from insurance is associated with an increase in infant mortality.
More
patient-friendly and liberty-enhancing reforms would allow patients and
providers to avoid the costly medical tort system via contract. Patients could
choose the level of protection against malpractice they desire, rather than
have that level imposed on them by the courts. Patients would select providers
who offer acceptable levels of compensation for injuries caused by negligence.
In cases of intentional wrongdoing or reckless behavior, tort rules would still
apply. Providers could offer patients a menu of compensation options and their
prices. Many providers likely would agree to high maximum awards to protect
against the risk of an astronomical jury award. Supporters of legislative caps
on damages could choose those limits for themselves. Patients who do not wish
to limit their protections would be free to do that as well. Enforcing such
contracts would mean that patientsnot legislatures or the courtswould
make tradeoffs between protecting themselves against immediate risks (the
illness for which they seek treatment) and more remote risks (potential
injuries from negligence). . . .
Some
will object that patients need all the protections that
Restricting
patients' freedom to make such decisions for themselves makes them less safe.
Patients would be better served by a competitive process that acknowledges that
one size does not fit all, allows patients to choose among diverse approaches
to malpractice protection, and rejects those that do not work. If the courts
will not respect Americans' right to make such contracts here at home,
legislators should ensure that such contracts will be enforced.
To read the rest of Part
III, Chapter 8 - Medical Malpractice Reform - please go to
the Cato Bookstore: www.catostore.org/index.asp?fa=ProductDetails&method=cats&scid=33&pid=1441272. The price is only $10. At that rate, consider
purchasing two or three and surprise those friends, who don't understand that
government involvement in health care is destroying affordable health care,
with a gift that keeps on giving. There are other excellent recent titles you
may want to consider. For Next month, read the
conclusions.
To read some of the other book reviews that
are available, please go to www.delmeyer.net/PhysicianPatientBookshelf.htm.
_______________________
Other Reviews
of Interest: "United 93" and "The Da Vinci Code":
"United 93": Facts of War: by Kathryn Jean Lopez: www.sacbee.com/content/opinion/v-print/story/14248911p-15066086c.html
Spellbinding 'United 93'
Recounts Doomed Flight With Soul-Searing Intensity, by Joe Morgenstern, In First Major Film on 9/11,
Director Skillfully Sets the Right Tone; Star Turn for an FAA Official, April 28, 2006; http://online.wsj.com/article/SB114617627110538025.html?mod=todays_us_weekend_journal
Seeking Truth at the Movies By JOHN J. MILLER,
* * * * *
10. Hippocrates & His Kin: Ethical Objections to the Ban on Organ Payments
Cannon
& Tanner, above, report that there is no shortage of transplantable organs.
Economists David Kaserman and A. H. Barnett estimate that each year enough
Americans die under conditions that make their organs suitable for transplant
to meet the entire demand. Yet most of these organs are buried with the
deceased rather than harvested to help the living. Instead of an actual shortage
of organs, there exists an artificial shortage created by the
prohibition of payments for transplantable organs.
That
prohibition is effectively a price control that sets the price of
transplantable organs at zero dollars in spite of the immense value they hold.
Because government prevents the price from rising above $0, it effectively
hides the potential providers information about the great need for
transplantable organs. In 2000, 539 economists signed an open letter on health
care reform that explained the dynamics of such price controls: "For
thousands of years, governments have tried to control prices. The universal
experience has been that price controls produces shortages . . ." To read more,
please go to www.medicaltuesday.net/hhk.asp.
Lloyd
Cohen of
* * * * *
11. Restoring Accountability in HealthCare, Government and
Society: