Entries Tagged 'Medicine' ↓

Experts Debate Mass Testing For Alzheimer’s Disease

Special to The Washington Post. Tuesday, December 4, 2007; HE01

You walk into the room, but you can’t remember why. You’ve forgotten where you left your keys. Lapses like that seem to be happening more often. The beginnings of Alzheimer’s disease? Maybe, maybe not.

What’s the best way to find out? Most experts say you should raise concerns with your physician. But an Alzheimer’s organization and an ad hoc panel that met last month say that anyone older than 65 — and anyone who has a family history of the disease — should request and receive memory tests on a regular basis.

The Alzheimer’s Foundation of America, a nonprofit advocacy group, endorses memory tests for all older Americans. And the Alzheimer’s Disease Screening Discussion Group — sponsored by Pfizer and Esai, the makers of the Alzheimer’s drug Aricept — recently urged screening for all those 65 or older or residing in an assisted-living or long-term-care facility.

But some experts worry that mass screening could do more harm than good by giving false reassurances to some and causing others needless worry.

One in seven Americans over age 71, about 3.4 million, have dementia. The majority, 2.4 million, have Alzheimer’s disease, according to a recently published study funded by the National Institute on Aging.

As people age, the odds of dementia rise. Of those 71 to 79, only 5 percent have the condition; for those 80 to 89, the figure rises to 24 percent; and for age 90 and older, it’s 30 percent, according to the NIA study.

Early screening, said Alzheimer’s Foundation chief executive Eric Hall, can help catch the disease when it’s still possible for drug therapy to help; it can also give family members more time to plan for caregiving, financial and other needs. Finally, a test might show that the memory loss is due to some other, more treatable medical condition.

For the past five years, the foundation has sponsored a National Memory Screening Day each November, when free screening is offered at 2,000 sites across the country. Participants are given a series of questions and tasks that take about five minutes to complete. If the results hint at any problems, they are told to follow up with their physician.

Edna Hayden, 83, said she’s glad she took the memory screen at her assisted-living facility in Fort Worth. She did so because she had been a bit forgetful, and because she had already learned, from a timely mammogram, that a screening can be a lifesaver.

She’s telling friends to get their memory tested. Either way, the testing can lead to action, Hayden said. “If they have [dementia], they can get help. If they don’t, they can have the relief of mind,” she said. (Hayden passed her test.)

But the <a href=”http://www.alz.org/”>Alzheimer’s Association</a>, another nonprofit advocacy group, does not support widespread screening, favoring one-on-one consultations with doctors instead.

William Thies, vice president of medical and scientific relations for the association, said there have been no studies proving the value of memory screening for the general public.

And there are downsides, he said. If someone is told his test is normal when it isn’t, he has been falsely reassured. If test-takers are wrongly told their results indicate a serious problem, they can have unnecessary anxiety. And if results that suggest a problem don’t prompt someone to talk with a physician, the purpose of the screening is defeated, Thies said.

Both the <a href=”http://www.alzfdn.org/”>Alzheimer’s Foundation of America</a> and the Alzheimer’s Association accept drug industry support.

Dallas internist and geriatrician Lynne Kirk, immediate past president of the American College of Physicians, said she performs tests only “when somebody has complaints or concerns about memory or cognitive function.”

For otherwise-healthy people, she doesn’t see the point. A normal result wouldn’t change her advice to patients to maintain brain and heart health by eating a balanced diet, exercising and keeping the mind active. And an abnormal result wouldn’t change that advice, either, and might only make someone worry, she said.

The Alzheimer’s Foundation would also prefer that people talk with their physicians if they’re worried about Alzheimer’s. But Hall said many people are afraid to raise concerns about memory loss because they are terrified of learning that they might have a progressive, incurable disease.

The foundation surveyed 1,900 of the 21,000 people it screened in 2006. About three-quarters said they had entered the screening thinking they might have a memory problem, but fewer than 10 percent of that group had ever discussed this concern with their physician. A fifth had not discussed it with anyone.

Thies said that the science currently doesn’t support widespread memory testing, just as it didn’t support cholesterol screening that some were pushing for in the 1970s, when the therapies then available for reducing high cholesterol had side effects that kept many people from taking them. When statin drugs emerged in the 1980s, the field moved forward, he said.

It took about 15 years for the debate to play out, Thies said. The controversy over Alzheimer’s screening is just getting started.

Many States Require Parity, and Congress May Order It Nationwide

Special to The Washington Post Tuesday, November 6, 2007; HE01

Q Why are my mental health benefits less generous than those that my insurance policy provides for other conditions?

A When mental health coverage was first added to benefits packages a few decades ago, there was still a persistent belief that a condition like depression was not as real as heart disease or cancer. There also were few medications or other therapies that offered significant improvement. Many employers did not offer rich coverage because they assumed the government would eventually pay for treatment of serious mental illnesses such as schizophrenia or bipolar disease.

Beginning in the early 1990s, as therapies improved and awareness grew that mental conditions are genuine illnesses, patient and professional groups and some in Congress began to press for federal laws to require equal coverage of mental and physical health, meaning for example equivalent co-pays .

The initial effort was led by Sen. Pete Domenici (R-N.M.), who has continued to champion the cause. Currently, 42 states, including Maryland, require equal coverage. The federal employees’ health benefit program also requires equal coverage. But 82 million Americans work for employers who self-insure, which means they are exempt from state parity laws, said Andrew Sperling, legislative affairs director for the National Alliance on Mental Illness. An additional 31 million are in other plans that don’t have to offer equal coverage.

In September, the Senate unanimously passed the Mental Health Parity Act, which would require equal coverage. The proposal has won the backing of three committees in the House. The chances for passage this year are good, experts say. “It’s a perfect storm in a good way,” said Carolyn Robinowitz, president of the American Psychiatric Association.

If I use my mental health coverage to talk to a therapist or get medications from a psychiatrist, could my employer use this information to treat me differently at work or maybe even fire me?

Despite growing awareness that mental illnesses are scientifically documented and treatable diseases, fear of discrimination still makes some people wary of admitting they have depression, anxiety or other conditions. And that makes many apprehensive about seeking treatment — much as people with cancer were fearful 20 or 30 years ago, Robinowitz said. Ron Honberg, policy and legal affairs director for NAMI, agrees that fear of discrimination is a barrier to care. “Whether it’s perceived or real, it’s something people worry about,” he said.

Some laws aim to offer protection: privacy laws to prevent disclosure of personal medical information to unauthorized users; and the Americans with Disabilities Act, which bars discrimination for a perceived disability, which could include a mental illness.

But the world is not perfect, and some people may be wrongly exposed or fired, as can be the case with pregnancy or any medical condition.

I’m worried about the cost of treating my mental disorder. Do counselors or psychiatrists ever adjust their fees?

You may be able to get treatment for a reduced fee. Many larger companies offer an Employee Assistance Program, which often provides limited phone counseling for free.

Public mental health clinics in most localities also offer some care free or at a reduced rate, depending on income. Your state’s mental health department help line can steer you to those clinics.

The American Psychological Association offers a consumer-oriented Web site as well as a referral service (800-964-2000); once connected with a local counselor, you can ask whether they operate on a sliding scale.

The American Psychiatric Association recommends asking practitioners if they will reduce fees, and offers other resources at Healthy Minds.

Georgetown University, George Washington University and Howard University offer mental health services, often at a reduced rate for lower-income individuals.

NAMI’s Web site also offers resources for patients. Robinowitz also suggests seeking help from support groups: Advocacy organizations for almost every disorder can be found in the phone book or on the Internet.

WASHINGTON

First published in the New York Times Science Section, June 17, 2003

As a boy, Cristian Samper rambled through the tropical forests of his native Colombia, marveling at the diversity that surrounded him. Not content to view the flora and fauna only in the abstract, he began what was to become a lifelong obsession and vocation, cataloging the diversity and assembling it into collections that forcefully argue for its preservation.

Now, at 37, Dr. Samper has just entered his third month overseeing one of the world’s largest collections, the National Museum of Natural History and its 125 million specimens. As director of the museum, the second-most visited of the Smithsonian centers (after the National Air and Space Museum), he is host to six million visitors a year.

Born in Costa Rica and raised in Colombia, he spent some of his youth in his mother’s home country, the United States. But it was his undergraduate field studies at La Planada Nature Reserve in Colombia that persuaded him to pursue graduate degrees and a career in the field. He later received his master’s and doctorate from Harvard. La Planada, he says, remains close to his heart, and he is continuing to study its tree growth and ecology in an effort to understand the nature of the Andean cloud forest. Before coming to Washington, Dr. Samper spent two years leading the Smithsonian Tropical Research Institute. “If you’re a tropical biologist, S.T.R.I. in Panama, especially Barro Colorado Island, which is in the middle of the Panama Canal, is about as good as it gets,” he said.

His stint there put him on the shortlist for the Natural History Museum job. Those credentials were bolstered by his service as chief science adviser to the Colombian Ministry of the Environment in the late 90’s, while he was setting up and running the Alexander von Humboldt Institute, a partnership aimed at creating science-based environmental policy. Dr. Samper was interviewed on a sunny June afternoon in his office overlooking the Mall, under the watchful eye of a very lifelike mountain lion poised in strike position.

Q. Did growing up amid the natural wonders of Costa Rica and Colombia have any influence on your future?

A. I think it did because when I was a kid I spent a lot of time going out walking and exploring. Every weekend we’d go for wonderful hikes in fascinating country. I think part of my fascination with biology was due to the surroundings. I remember ever since I was a small kid I started doing amazing collections of insects and plants and all kinds of creatures. We used to spend some holidays at some relatives’ farm, and they had this fantastic swimming pool in the middle of the forest. I’d go in there, but I didn’t swim. All I would do is collect the bugs and insects that would fall in the water and try to catalog them.

Q. What plans did you think your parents had for you?
A. There was one moment when I was about 13 or 14 years old where I decided I had this fascination with animals, and I was thinking of being a vet. My parents, with their good wisdom said, “Well, that’s fine as long as you’re a really good vet.” They set up this summer internship with the family vet. Most of what I got to do was shampoo French poodle dogs and cut their toenails, and the most exciting thing was a rabies shot for the dog, and that was about it. So at the end of the second month there, I decided it wasn’t quite the kind of excitement I had in mind.

Q. What prompted you to return to Colombia for your research?
A. My love for the country. I wanted to try to go back and make a difference.

Q. You were science adviser to the Ministry of the Environment and testified before the Colombian Congress on issues like drug eradication. Did you ever fear for your life?
A. It’s gotten progressively worse over the last 10 years, so, yes, it was always at the back of my mind. I don’t think it was so much because of my position; it was because of the fact that we were living in this country, Colombia. At the Humboldt Institute we did fieldwork in some of the most interesting areas biologically, which were almost invariably correlated with the ones most difficult to work in politically. We developed a protocol of how we would actually go into those areas to avoid problems. It was completely counterintuitive because the first reaction of people going to those areas was, We have to sneak in and out and avoid being noticed. We did exactly the opposite. Our policy was whenever we were having expeditions to some remote mountain corner, we would send a scouting team ahead to spend a weekend at the local bar, preferably in the town square, drinking beer, talking to everyone and actually giving out handouts about who we were and what we were doing.

Q. How do you think you will respond to pressure to mount certain exhibits or change them?
A. I believe the strength of this museum, the core of this museum, is the science. And science has to be intimately linked to the collections and exhibitions. My priority is making sure that our exhibits are objective and based on the best science available.

Q. How do you hope to shape the museum’s mission and exhibits?
A. I often come in on weekends and just mix with the crowd, the visitors, and look at their reactions and talk to them. And I think there are many people coming to this museum who don’t realize how much research is behind the scenes. And I think that’s one area where we can probably do a better job in the future. I believe the American people think of the Smithsonian as museums of gadgets, or the nation’s attic. We have to remember that the Smithsonian and the collections here are not only objects, it’s the scientific process behind them.

Q. What do you think can be done about the loss of rain forests?
A. Anything we can do that will lead us toward a sustainable use of natural resources is important. Now I don’t have full confidence in our ability to do that, and I think we do need some backstop measures, including setting up protected areas. I’m convinced that science has to be at the cornerstone of efforts on conservation. At this point we have not cataloged more than 10 percent of all living species on earth, and that’s shocking, after 200 years of work. We probably know more about the surface of the moon than we know about the Amazon rain forest.

Q. Is it a good thing for the jungle to be seen as a cornucopia of new medicines, foods and materials?
A. I’ve seen indigenous communities in parts of Colombia where people have come in and said, You have to preserve this rain forest because this is a cornucopia, here’s a cure for cancer, and you’re going to be rich. But of course, getting from this leaf to that cure and getting the money back is something that really needs to be worked out. The problem that I’ve seen with that is that it has generated expectations that cannot be met in the kinds of time frames that local people are expecting.

WASHINGTON —

First published in the New York Times Science Section – August 6, 2002.

Over its 140 years, the National Museum of Health and Medicine has been a destination for amateur Civil War historians, medical researchers and tourists with a penchant for the macabre. The museum, on the campus of the Walter Reed Army Medical Center in Washington, still has plenty to satisfy the prurient, but over the last five years it has put away more of its gruesome artifacts and edged further into the museum mainstream. “We have moved with the times, so we have a more contextual approach,”said Dr. Jim Connor, assistant director for collections.

The museum’s displays used to consist of large numbers of similar objects— rows of bones with the same fracture, or jars of brains, each showing the effects of a stroke, or case aftercase of microscopes through the ages. Now, a few specimens are incorporated into bigger-picture exhibits. The current installation of art about orthopedic injuries and healing, for example, includes spines mangled by scoliosis. The change came largely because a growing part of the 75,000 yearly museum visitors work outside of medicine. And they often asked how the specimens got the way they were, said Dr.Adrianne Noe, the museum’s director, prompting her and her staff to strive for greater context in the exhibits and installations. But Dr. Connor said the museum would never abandon some of its moreshocking displays. Those, he said, give the museum “particularity.” And, he added, many visitors come specifically for the graphic reality. “Our audiences aren’t shocked but are actually enthused,” he said.

There are a number of disturbing specimens: a stomach-shaped giant hairball taken from a 12-year-old girl who compulsively ate her hair; a swollen leg floating in a murky formaldehyde bath; a skeleton, sitting in a rocking chair, that belonged to a man whose every bone was fused together by arthritis. Researchers come for the developmental anatomy collection and the neuroanatomical collection, which includes 37,000 normal and diseased brains and human and mammalian brain tissue specimens, among other assorted collections. As part of the Armed Forces Institute of Pathology, the museum serves three military branches.

It was founded as the Army Medical Museum in 1862, with a mission of studying diseases andinjuries from the Civil War. By the war’s end, the museum had amassed about 2,000 bones, mostly amputated arms and legs. The military surgeons’ notes detailing the damage to each specimen, whether inflicted by lead Mini balls, bayonets, gangrene or cholera, were collected into a six-volume set, “The Medical and Surgical History of the War of the Rebellion.” It is a quintessential study of battlefield wounds, infections, treatments and outcomes.

One of the museum’s top draws is the shattered leg bone of Maj. Gen. Daniel E. Sickles, a former Tammany Hall politician and famous rogue who is the subject of a recent biography by Thomas Keneally. After being injured at Gettysburg, Sickles sent his leg to the museum in a coffin-shaped box. He visited it each year on the anniversary of its amputation.

After Abraham Lincoln’s assassination, at Ford’s Theater, the museum took over the space, occupying it from 1866 to 1887. Army surgeons conducted Lincoln’s autopsy, and they kept skull fragments, hair and the bullet that pierced the president’s brain. All the items remain on display. Out of public view is a section of John Wilkes Booth’s spine, showing the trajectory of the bullet that killed him.

The museum is active in the present, too. Paul Sledzik, curator of the anatomical collections, has weighed in on several modern mysteries, including that of a partly mummified body left on the doorstep of a West Virginia flea market. Mr. Sledzik determined the organs had been preserved with cornstarch,a method popular in the early 20th century. He placed the skeleton in that era and said it probably had been in atraveling freak show, relieving local fears that it was a more recent specimen.

The museum’s display capacity has shrunk drastically since it was moved from its own building on the Mall to Walter Reed in the early 1970’s. Less than 1 percent of the museum’s collections are on display, said Steven Solomon, a museum spokesman. Some specimens — like President Dwight D. Eisenhower’s gallstones and the skeleton of Ham, the first chimpanzee in space — are in back offices. But most of its treasures are kept in a Gaithersburg, Md., warehouse.