July 31, 2014

Drug Studies MUST Include Seniors

I was pleased to see a recent op-ed piece in the New York Times -- "You’re Never Too Old to Be Studied" -- that made an important plea: Include seniors regularly in tests for drugs and medical devices.

How do we know that seniors are under-represented in clinical tests? In 2007, the Journal of the American Medical Association reviewed randomized controlled trials conducted between 1994 and 2006, and discovered that about 40 percent of those studies completely excluded people over 65 years of age.

The authors of the New York Times piece – Donna Zulman and Keith Humphreys – reminded readers that Americans 65 and up now represent about 13 percent of our population.  By 2030, that percentage will reach 20 – one in five Americans.

How can doctors confidently prescribe a course of action for such a big chunk of their patients when that group has essentially been excluded from the very tests designed to help healthcare professionals determine and recommend a medical plan?

Excluding seniors from these important tests has been a mistake… a misstep – thankfully – that can and should be corrected.

Women, Too
The same foolish under-representation has applied to women, too.  Only in 1993 – hard to believe, just 21 years ago --  did the National Institutes of Health (NIH) begin requiring studies to include women. Just two months ago, the NIH urged study leaders to include more female lab animals in their research… another step in the right direction.

As we’ve seen with women, seniors often need different treatments – and certainly reduced drug dosages – than the healthy younger patients who swell the study ranks. Like women, seniors usually weigh less than those younger study subjects. Seniors typically have reduced liver and kidney function, and therefore process medications differently. As a result, seniors are more likely to experience adverse reactions – dizziness, drowsiness, depression… or worse – than their younger cohorts.

In the past, study leaders have excluded seniors for some of those very reasons, citing the complex health issues they thought created ethical or practical problems for their studies.

But, as Zulman and Humphreys write, “Advanced age is not a reliable proxy for poor health.” Excluding any group of people from studies must not be based on age alone.

July 30, 2014

More Chronic Conditions = Fewer Years on Earth

Researchers from Johns Hopkins Bloomberg School of Public Health recently published this piece of news: the more chronic diseases you have, the shorter your life expectancy.

According to senior study author Gerard Anderson, a professor in the Department of Health Policy and Management at Johns Hopkins: "When you’re getting sicker and sicker, the body’s ability to handle illness deteriorates and that compounds. Once you have multiple conditions, your life expectancy becomes much shorter.”

By itself, that news isn’t all that surprising; people with a combination of illnesses are more likely to die before their healthy neighbors.

But here’s where the news gets more troubling. Compared to people in other developed countries, Americans already have a so-so life expectancy (#35 on the list, according to the World Health Organization's 2013 rankings, shown below). Now, those Hopkins researchers report that the life expectancy for Americans – which has been rising by about .1 years each year – is not maintaining that steady growth. Unlike citizens in other developed nations, Americans now have a decelerating life expectancy.

The Danger of Multiple Chronic Diseases
Why? Americans are developing more and more health problems. In fact, the Hopkins study reports that a whopping 80 percent of all Americans over 67 have multiple chronic illnesses. 

While we can boast about hospital quality here, the American healthcare system – by far the most expensive per capita in the world – doesn’t meaningfully serve the same high percentage of residents that we see in other developed countries. 

At the end of the day, it boils down to this: Americans don't choose wisely when it comes to the Holy Grail of wellness: diet and exercise.

The likely culprit in America is our obesity epidemic. Three of most common chronic diseases in America -- heart disease, high blood pressure, and diabetes – are all conditions that find accommodating hosts in obese people.

July 29, 2014

The Benefits of Saying "I Don't Know" in Business... and Medicine

A few months ago, a friend said he liked it when people answered questions with “I don’t know.” He thought the response was all too rare, that it showed strength – not weakness, that it showed wisdom – not ignorance, and that it encouraged dialogue, engagement, exploration. 

He said he feels like running for the hills when in the company of people who are sure about everything (even the big questions that don’t – and can’t -- have answers) and who rarely miss the opportunity to pontificate on their positions.

No, there’s nothing wrong with having clear, well-reasoned opinions on all the important topics of the day. Still, I understood my friend’s comments.

Soon after, I saw an article by ad man Curt Hanke on the business site Inc.com. The title? “The Power of ‘I Don’t Know.’”

Hanke began by citing a 2012 IBM study of companies’ chief marketing officers. When these executives were asked if they were prepared for all the unpredictable complexities and changes coming their way over the next five years, 52 percent of the CMOs said “no, I do not feel prepared.”

The author wasn’t surprised that so many executives acknowledged uncertainty about all the mysterious and unknowable developments that lay ahead for their industry. Instead, he was amazed that so many – 48 percent – felt prepared. Did they really feel prepared? Was their positive response driven by bravado – or the deadly fear of appearing weak – as much as anything else? Were they simply unable to say “I don’t know”?

In his essay, Hanke described four benefits that come to leaders when they say “I don’t know.”

July 28, 2014

Bergen, Norway: "It's Only a 10-Minute Walk." Yeah, Right.

In the past, I'd land in a new city and charge around trying to fill the day with as many new sights and experiences as possible. That was then.

My day last week in Bergen, Norway -- where the ship docked for ten hours -- showed me just how things have changed... and how this 85-year-old has adapted.

Avoiding my typical long list of must-do's, I narrowed the agenda this time to a stroll through the popular harbor Fish Market, and the funicular ride to the top of Fløyen mountain, one of Norway's most popular attractions. By 10:30am -- after a leisurely breakfast -- I was ready to go.

My two travel mates, concerned about my touring alone, said they'd be happy to accompany me, and at my own pace. I appreciated the offer, but knew I'd hold them back. I also knew I'd end up hurrying and pushing myself, not wanting to slow them down too much. It was a discussion we had quite a few times through the trip.

So, off I went on my own.

The First "Ten-Minute" Walk
Before I disembarked, I asked a ship staffer how long it would take to walk to the waterfront. The answer: "Just about ten minutes."

Here's the view as I left the ship and headed for town: shade on the left, sun on the right. I chose the the shady side of the street.

Why the shady side? Recently, when I've exerted myself in midday heat and humidity, I've often experienced a reaction not uncommon among Parkinsonians: orthostatic hypotension, a sudden drop in blood pressure typically caused by standing up. During these scary events, my systolic number often drops below 100.

July 25, 2014

Another Love: Helen Mirren

Dame Helen Mirren is certainly different from my last week's love, Billie Holiday. I was happy to see an interview with the actress in a recent edition of "AARP the Magazine."

Can you believe she's 68 years old?

During her 45-year career, she has portrayed three British queens in different films and television series: Elizabeth I in the television series Elizabeth I (2005), for which she received an Emmy and a Golden Globe Award for Best Actress; Elizabeth II in The Queen (2006), which won her an Oscar and the BAFTA Award for Best Actress; and Charlotte of Mecklenburg-Strelitz in The Madness of King George (1994), for which she earned an Academy Award nomination for Best Supporting Actress. She is the only actress to portray both Queens Elizabeth on the screen.

To be sure, she's one of the world's great actresses. But she is also a bright and fun dame who has been outspoken on many topics. Here are just a few examples:

Dame Mirren on Social Media
In her conversation with AARP the Magazine, the actress comes across as down-to-earth, sassy, self-deprecating and devilishly opinionated. Asked about the time-sucking quagmire that is social media, Mirren says:
It reminds me of a stinky old pub. In the corner would be this slightly disgusting old man who sits there all day, every day. If you went up and talked to him, you'd get the kind of grumpy, horrible, moldy, old meaningless crap that you read on Twitter.