The Power of Placebo

In a recent issue of the New Yorker, long-time staff writer Michael Specter explored the nature of the placebo effect in medicine, primarily by describing the work of Ted Kaptchuk, who directs Harvard University’s Program in Placebo Studies and the Therapeutic Encounter (PiPS). The program’s mission is “to examine the placebo response and the implications of medical ritual, the patient-provider relationship, cultural context, and the power of imagination and hope in the healing process. Through endeavors in the clinical, basic, and social sciences, bioethics, the history of science and philosophy, PiPS seeks to elucidate, quantify, optimize and reaffirm the humanistic and more intangible dimensions of health care.”

Kaptchuk, who studied Chinese medicine in Macau and practiced acupuncture for many years, is arguing for a shift in contemporary medicine away from high-tech and pure science to a greater emphasis on healing. Having recently received funding from the National Institutes of Health, he and his colleagues are undertaking neuroimaging and molecular studies to understand the biological underpinnings of the placebo response.

In one study, he and his group acknowledged that a problem in directly exploring the placebo effect in a clinical setting was the use of deception — not letting patients and providers know of they are receiving an active drug or not. So they designed a randomized study in which patients with irritable bowel syndrome were given pills they were told were “an inert substance, like sugar pills” or no treatment. After 21 days, patients given the placebo had significantly different changes on global improvement scores (5 versus 3.9, P=0.002) and symptom severity (P=0.03).

In another study, patients with asthma were randomized to treatment with an albuterol inhaler, a placebo inhaler, sham acupuncture, or no treatment. The albuterol group experienced 20% improvement in forced expiratory volume in one second (FEV₁) measured on spirometry, and the other three groups all improved by 7%. However, when patients were asked if they felt better, 50% on albuterol reported improvements, as did 45% of those using the placebo inhaler, and 46% of those who had sham acupuncture, compared with only 21% of those who had no treatment (P<0.001). The researchers concluded that, while objective measures such as FEV1 are important in asthma care, “other outcomes such as emergency room visits and quality-of-life metrics may be more clinically relevant to patients and physicians.”

Specter concludes his article with a personal anecdote. He had been experiencing chest pain and was worried, being an overstressed middle-aged man, so went to his doctor, who conducted a careful examination. The physician told him he was fine, but needed to relax — and the pain simply disappeared. This was an example of “exactly the type of ritual that, according to Kaptchuk, will have to play a critical role in the future of American health care.

So what do you think should be the role of placebo — if any — in tomorrow’s medicine?

Original article: The Power of Placebo http://bit.ly/t39hKo from @medpagetoday

Discovery May Lead To New Cystic Fibrosis Treatments

PR Log (Press Release) – Mar 11, 2010 – Discovery may lead to new cystic fibrosis treatments

A new discovery may give hope to the thousands of cystic fibrosis sufferers around the world.

According to a research team from the University of California, San Diego School of Medicine, they have identified a defective signalling pathway which increases the severity of cystic fibrosis, a condition which affects one in 2,400 people in the UK, and of which four per cent of the population are carriers.

In the report, published in the February 14th edition of the journal Nature Medicine, lead investigator Dr Gregory Harmon and study supervisor Dr Christopher Glass, professor of cellular and molecular medicine at the facility, say that the discovery may be able to significantly reduce symptoms in sufferers.

The specialists revealed that defective signalling for a protein called the peroxisome proliferator-activated receptor-y (PPAR-y) accounts for a portion of disease symptoms in cystic fibrosis, and that the correction of the defective pathway reduces symptoms of the disease in mice.

Dr Harmon pointed out that cystic fibrosis results from a genetic mutation in a membrane pore that facilitates the transport of chloride and bicarbonate electrolytes from inside the cell to the spaces outside the cell.

He added: "Loss of the cystic fibrosis pore channel results in inflammation and mucus accumulation. It also results in dehydration of the cell surfaces that make up the lining spaces inside the lungs and other affected organs, such as the intestinal tract."

Dr Harmon revealed that the fact a drug may be able to activate bicarbonate transport without affecting chloride transport is what could result in an improvement in the disease.

"The finding of the reduced PPAR-y activating prostaglandin in cystic fibrosis is exciting since it could serve as a marker to identify which patients might benefit from treatment," the expert concluded.

find original article at http://www.prlog.org/10570893-discovery-may-lead-to-new-cystic-fibrosis-treatments.html

Is Loving Salt a CF Thing??

I'm probably the only one, but I found the following article fascinating for two reasons: I'm from Arizona and I love salt.

Now, I do have a little background to give you on my love AND hate relationship with salt however. While growing up I added salt to anything and everything...and I mean everything. I was one of those, salt first, eat second, salt again and then decide if I should put more salt or not. I distinctly remember adding salt to my red jello on Thanksgiving Day 1991 and I LOVED it. I'm telling you guys, I was a walking and talking salt-adding machine.

Like many of you, I also became a salt lick with any sort of physical activity. I used to always make jokes with the guys and lean over there fries and ask them if they needed any more salt with that. My hats were always surrounded with a salt rim and I was constantly becoming blind by the salt crystals that would drip into my eyes.

My relationship with salt took a turn for the worse however in 2003 when my kidneys were having a rough go of it in the hospital. I was actually flushed out with fluids and then asked to leave by my docs cause they couldn't in good faith give me anymore antibiotics. My kidneys were being damaged and they didn't want to harm them any further. I asked them about some simple steps I could take to help my kidney function and they came up with two suggestions: Drink more water and stop adding table salt to my food. To make a long story short, I've added table salt to my food ONE time since 2003. It was to some canned corn last year that I just wanted to see what it tasted like again. I've had a few issues here and there with my kidneys, but they've never been as bad as they were in 2003. Was it the strict "no table salt diet"? Who really knows right?

Ok, so I totally got sidetracked there, but I'm still wondering; Do cysters and fibros have a special affinity for salt? Is it just a coincidence that I've met many who crave salt just as our cells crave the balance of salt and water (super layman's terms there)? I don't know, you tell me.

Here's the article though:

Arizona is taking steps to improve the health of its residents. The state joined a national initiative to cut 20 percent of sodium from diets in the next five years.

"Most people are eating twice as much salt as they should and about 80 percent of it comes from pre-processed foods, like canned soups and frozen dinners," said Will Humble, Interim Director of the Arizona Department of Health Services.

"The fact is the sodium line in the nutrition facts label is just as important as the fat line, but it's often ignored. The overall goal is to get food processors to reduce the amount of salt in their products. Until that happens, everyone has to pay a lot more attention to the sodium information in the nutritional facts."

A recent study in the New England Journal of Medicine found that cutting dietary salt by three grams per day could reduce coronary heart disease and stroke.

Humble says if we cut 30 percent of the salt out of our diet, it would have the same benefit as half the smokers in the state quitting.

"If we were able to knock back 30 percent, the amount of salt that folks eat here in Arizona by 30 percent, it would be the public health equivalent of getting half of Arizona smokers to quit cold turkey today," said Humble.

Too much salt causes things like high blood pressure which leads to higher medical costs.

"Every year in Arizona, we spend between 200 and 400 million dollars that we don't need to spend on controlling blood pressure and the consequences that come from eating too much salt," said Humble.

Humble says a lot of salt comes from processed foods which makes cutting back on salt harder than you think.

"Initially, folks think, ‘Well, I don't use much salt from the salt shaker so I'm okay.' Well, you're not okay because 80 percent of the salt that you're getting is coming from processed foods," said Humble.

One way to reduce sodium intake is to watch what you buy at the grocery store and the places you eat. Fresh fruits, vegetables and meats are naturally low in sodium, while the amount in processed foods varies greatly. Nutrition labels help make healthy choices about sodium in bread, sausage, chips, etc.

Full article at http://ktar.com/?nid=6&sid=1264096

Do We "Domesticate" Death in the CF Community???

Last week I read an article that got me really thinking. It was splattered with ethical dilemmas and question arousing issues. Read THIS article first, read the blog, and then share your thoughts...

The CF community is faced with questions and situations that could never be explained or understood by others. For me, one of the most interesting is the concept of expecting and accepting death from a young age. This article mentioning trying to "domesticate" death and talking about it to the extent that you're almost too comfortable with it. If you're anything like Ronnie and I, it's not discussed very often, but it's understood and becomes a factor in many decisions. Ronnie has never pictured himself being an old man, but expects to live a long life...a result of years of knowing that CF shortens your life. While I teeter between expecting and hoping for the ideal, long life together, and envisioning losing him at a young age. I think for me, it's a coping method. I tend to get my head wrapped around something so much so that I am disappointed when it goes any other way, and want to make sure that that is not the case in this situation. And while Ronnie is healthy, we both fully grasp how fleeting that health could potentially be. We discussed early on in our relationship the possibly of death at an early age...a conversation not had by many couples in their 20s. A conversation we hope is completely hypothetical. A concept we understand could be a reality. What are your thoughts? Is it unhealthy to talk too much about death. Does talking about it enough make you too comfortable with it?

This article also uncovers the issue of remarrying. If your spouse dies, at any age, at what point, if any, is it ok to move on; to allow yourself to love again? I think the answer is different for everyone, but what is my answer? I'm not sure. I wouldn't say to Ronnie that I'd never remarry. That's a promise I don't know if I could or should make. How do you navigate a second relationship when you haven't let go of a first? Is there a way to remain in love with one person while loving another? All questions I don't think anyone has the "right" answer to, but I'd love to hear your thoughts.

The last interesting theme of the article is the moral dilemma of using frozen sperm from a deceased husband, after remarrying with two children. This is something I've never thought about. Interesting predicament. Just thought I'd open up conversation about it...but I have no thoughts of my own to add!

There sure is a lot of room for discussion with many of the issues this article unfolds. I'm sure the topics are ones you've thought about at one point or another. I'd love to hear your thoughts.

Let's Celebrate the Small Victories!!!!

I'm all about celebrating small victories when it comes to Cystic Fibrosis. After this report came out I think all of us in the CF community have at least a little reason to celebrate. I think this calls for a big slice of cake with buttercream frosting! Care to join?

CFRD Incidence, Mortality Rates Narrowed

Cystic fibrosis-related diabetes is present in 2% of children, 19% of adolescents and 45% to 50% of adults aged older than 30 years, according to a review of data from 1992 to 2008.

The review revealed that previously noted differences in cystic fibrosis-related diabetes between sexes and gaps in mortality have disappeared and considerably narrowed, with the exception of a higher prevalence in women aged 30 to 39 years.

“Diabetes is exceptionally common in cystic fibrosis, especially as cystic fibrosis patients get older,” Antoinette Moran, MD,toldEndocrine Today.

“In the past, the added diagnosis of diabetes has meant a patient (especially a woman) with cystic fibrosis is at increased risk for early death — this is no longer the case,” she said. “We believe the difference is that we are now screening effectively so that we diagnose early and we are treating it aggressively.”

Moran and colleagues at the University of Minnesota examined current trends in the incidence, prevalence and mortality related to cystic fibrosis-related diabetes using a comprehensive clinical database. The review included 872 patients with cystic fibrosis followed at the University of Minnesota during 1992 to 1997, 1998 to 2002 and 2003 to 2008.

Current trends

During 15 years, cystic fibrosis-related diabetes mortality rates decreased by more than 50% in women, from 6.9 deaths per 100 patient-years in 1992 to 1997 to 3.2 deaths per 100 patient-years in 2003 to 2008. Rates also decreased in men — 6.5 deaths per 100 patient-years in 1992 to 1997 to 3.8 deaths per 100 patient-years in 2003 to 2008.

The overall incidence of cystic fibrosis-related diabetes was 2.7 cases per 100 patient-years, with the exception of women aged 30 to 39 years in whom the incidence more than doubled.

Previously, diabetes was diagnosed as a perimorbid event in nearly 20% of patients with cystic fibrosis. During 2003 to 2008, only two of 61 patients diagnosed with diabetes died.

Cystic fibrosis-related diabetes without fasting hyperglycemia predominated in younger patients; however, the presence of fasting hyperglycemia rose with age.

Still, lung function is worse in patients with cystic fibrosis-related diabetes compared with patients without diabetes. Nutritional and pulmonary statuses were similar between patients with and without fasting hyperglycemia.

The data are “encouraging” because “diabetes is an expected condition as individuals with cystic fibrosis grow older,” Moran said during the interview.

The researchers attributed several reasons to the improved incidence, prevalence and mortality rates related to cystic fibrosis-related diabetes, including more aggressive treatment and early diagnosis.

Better antibiotics, digestive enzymes and respiratory therapies may have also contributed to the changes. “However, these therapies affect all people with cystic fibrosis and it is those with diabetes who have shown the greatest improvement,” Moran said.

Moran A. Diabetes Care. 2009;32:1626-1631.

If you'd like to stay up on current research articles on Cystic Fibrosis, I would suggest making your way over to the No Excuses blog. Amy does a great job staying current on all of the latest research.

Interesting article about Bacteria

Deep Inside Bacteria, a Germ of Human Personality

Bacteria are the oldest living things on earth, and researchers have long felt that they must lead dull, unfussy lives. New discoveries are starting to show just how wrong that notion is.

For a simple, single-cell creature, a bacterium is surprisingly social. It can communicate in two languages. It can tell self from nonself, friend from foe. It thrives in the company of others. It spies on neighbors, spreads misinformation and even commits fratricide.

"Really, they're just stripped-down versions of us," says Bonnie Bassler, microbial geneticist at Princeton University, who has spent two decades peeking at the inner lives of bacteria. Dr. Bassler and other scientists are using this information to devise new ways to fight infections and reduce antibiotic resistance.

Bacterial society is based on a chemical language called quorum sensing. To detect how many of its own species, or members of another bacterial species, are in the immediate vicinity, each bacterium secretes a certain molecule into the environment. The greater the number of molecules it can sense, the more fellow bacteria it knows are out there.

This is often a trigger to act. Some bacteria will attack a person or any other host only after establishing that there is a quorum -- a large-enough army to overcome the host's immune defenses. The strategy helps explain the virulence of a number of human ailments, including cholera, pneumonia and food poisoning.

Dr. Bassler was the first to identify the molecule that bacteria use to communicate with members of other species. She hopes the finding will lead to a new kind of drug that won't succumb to antibiotic resistance.

Resistance is a serious and growing health risk across the world. It occurs because most antibiotics are designed to kill bacteria. But some bugs survive the attack and pass on their resistant genes to their progeny, strengthening future generations and making the antibiotic less effective.

Instead of killing bacteria, Dr. Bassler wants to simply jam their communication lines -- the quorum-sensing mechanism. She figures that if the bugs can't signal each other, they can't properly assess the size of their growing army and might never attack. Another benefit: Because bacteria aren't killed, the approach could delay the onset of resistance.

To continue reading the article click here

Original article can be found at http://online.wsj.com/article/SB125236107718690619.html?mod=googlenews_wsj

NY Times Article on CF

Good article. Check it out....

http://health.nytimes.com/ref/health/healthguide/esn-cystic-fibrosis-ess.html