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Paying Tribute To A Doctor’s Invaluable Teacher: A Dead Body

For many doctors, the most important person on their journey from pre-med to licensed healer is dead.

“When you start medical school, you begin to learn the details of cells and tissues and development and disease,” said Jared Wortzman, president of the Tufts University School of Medicine class of 2016. “But if you ask anyone here they’ll tell you, you don’t really become a medical student until the moment you meet your cadaver.”

Edmund Chilcoate in his Coast Guard days (Courtesy)

Edmund Chilcoate in his Coast Guard days (Courtesy)

Wortzman spoke at an unusual gathering last week — a memorial service for the men and women who donated their bodies to the anatomy lab at Tufts and a reception for their families.

One of the donors was 83-year-old Edmund Chilcoate.

“This is when he was a baby. He was cute, wasn’t he cute?” said Kim Begin, one of Chilcoate’s two daughters. Begin flips the plastic-covered pages of a brown leather photo album while three of the first-year medical students who probed and dissected Chilcoate’s body lean in to look.

Continue reading

Say ‘Om’: Researchers Find Gene Action Altered After Relaxation Practice

(Synergy by Jasmine/flickr)

It’s widely accepted that yoga, meditation and other practices that involve conscious relaxation can reduce stress and enhance a person’s general well-being. But for many, notions of “mindfulness” and “wellness” still come off as a tad New Age-y and amorphous.

So here, for skeptics, is a molecular-level reality check: Researchers at Massachusetts General Hospital and Beth Israel Deaconess Medical Center report that the relaxation response – a state of deep rest attained through breathing, meditation, yoga and other practices — triggers changes in gene expression that can affect the body’s immune function, energy metabolism and insulin secretion. The new research — the first to look at rapid, gene-level changes following the relaxation practice — is published in the journal PLOS ONE.

Herbert Benson, a senior author of the new study, first described the “relaxation response” — what he calls the physiologic opposite of fight-or-flight — nearly 40 years ago. He’s now the director emeritus of the Benson-Henry Insitute for Mind-Body Medicine at MGH, where the technique is used to help patients manage a wide variety of medical conditions from anxiety and chronic pain to cancer.

Benson says the new research should give a credibility boost to his endeavors (which, by the way, non-Westerners have been practicing in various forms for thousands of years). “There’s now a scientific basis for these mind-body approaches that work,” Benson said. “For the mainstream, every little bit of evidence helps.”

Benson’s collaborator, Towia Libermann, PhD, director of the Beth Israel Deaconess Medical Center (BIDMC) Genomics, Proteomics, Bioinformatics and Systems Biology Center and co-senior author of the study, says the evidence clearly links the relaxation response to rapid changes in gene expression. “There is a relatively small subset of biological pathways affected by relaxation response,” he said. For instance, a pathway involved in immune disturbances and inflammation was repressed after the relaxation technique while another set of pathways involved in mitochondrial function and energy production were enhanced. Continue reading

Harvard ‘Winding Down’ Research Center Where Monkeys Died

Harvard is winding down operations at its controversial primate research center where four monkeys died, according to Harvard Medical School and this report in The Boston Globe:

The Harvard primate research center where four monkeys died because of animal care problems will be largely shut down by 2015, Harvard Medical School announced Tuesday afternoon. The university cited a tough economic climate for biomedical research funding and shifting long-term strategic plans.

(New England Primate Research Center/Harvard Medical School)

(New England Primate Research Center/Harvard Medical School)

The announcement stunned outside researchers, because it comes a year and a half after Harvard began investing significant time and resources into the New England Primate Research Center in Southborough, to correct animal care and oversight problems that had resulted in the deaths of four monkeys between June 2010 and Feb. 2012.

From the Harvard Medical School news release:

Boston, MA (April 23, 2013)—Harvard Medical School announced today that it would wind down operations of the New England Primate Research Center (NEPRC) over the next 12 to 24 months rather than seek to renew a five-year federal grant to continue operating the Center, and indicated its leadership had begun to work with the National Institutes of Health (NIH) on a transition plan.

School leaders acknowledged that the decision to wind down operations of the NEPRC was extremely difficult in light of the groundbreaking research that has been conducted at the Center over the past 50 years. As they weighed whether to renew the base grant from the NIH, HMS leaders made a strategic decision based on a review of the long-term academic benefits and the financial cost of continuing to operate the NEPRC. Continue reading

Expert: Suspect Images Clear Now, But Prevention Too Complex A Task

You can’t help but ask: If we can see these clear suspect images shared by the FBI now, couldn’t someone possibly have detected the threat before the fact and headed off all that mayhem?

In short, the answer is no. That is simply too complex a task, beyond our human and current technological capabilities, said Prof. Jeremy Wolfe, a visual attention researcher in the departments of ophthalmology and radiology at Harvard Medical School and Brigham and Women’s Hospital. His take on the challenge:

With all these videocameras all over the place providing a mountain of data, somebody is likely to ask if, given that the signs were all there ahead of time, shouldn’t someone have seen this coming? Sadly, that task is essentially impossible, at least at this point. When you don’t have anything specific to look for or a specific place to look, even though you’ve got all this footage, there’s no way to do it.

For example, imagine this problem: Remember the bombs a few years ago in the London subway? You’ve got video cameras everywhere in the London subway. After the fact, you can see the bomber, carrying a backpack down into the subway and coming out without it. Before the fact, you just don’t have enough humans to look at all that imagery of all the people on the ‘Tube”. Perhaps we could use a computer.

Now imagine trying to create a computer program that will mark everybody as they go into the subway, find them again when they come out of the subway — in a different place, of course — and figure out if they are still carrying their backpack. If you think about that for a moment, you realize that is a monumentally hard problem. And that’s actually a smaller problem than the problem of ‘Is anybody doing anything suspicious in Boston today?’

The problem is still hard, but much more tractable, after the fact. Now you concentrate on a restricted range of time and a very restricted place. This probably still involves quite a lot of footage but we can point human eyeballs at every bit of that footage. We can fast-forward and rewind and turn this from an absolutely impossible search task to really quite a tractable one. It’s going to be difficult but it’s quite a tractable identification task.

In the case of the Boston bombing, you might have a pretty good idea that you’re looking for something like a black nylon bag. When you see it, you back up in time to see when it’s not there. Continue reading

Proof In The Pants: A Pivotal Moment In Pre-Viagra History

Dr. Abraham Morgentaler, author of the new book, "Why Men Fake It: The Truth About Men And Sex." (Courtesy Henry Holt)

Dr. Abraham Morgentaler, author of the new book, “Why Men Fake It: The Totally Unexpected Truth About Men And Sex.” (Photo: Adrien Bisson, Courtesy Henry Holt)

I can’t remember the last time a piece of important medical history made me gasp, drop my jaw and then explode into disbelieving laughter. But such was the effect of the passage below from Dr. Abraham Morgentaler’s new book, “Why Men Fake It: The Totally Unexpected Truth About Men And Sex,” which will be officially published April 16.

Now, I don’t blame you if you find it a tad hard to believe that a prominent scientist at a major medical conference would in fact drop his pants and ask audience members to check his “degree of tumescence.” (Oops. Spoiler alert.)

But I found confirmation from a second source in a medical journal, this similarly hilarious account in the journal BJUI, formerly known as the British Journal of Urology: How (not) To Communicate New Scientific Information: A Memoir of the Famous Brindley Lecture.

(AP photo/Daniel Roland)

(AP photo/Daniel Roland)

Just to set the scene: We’re back in the 1980s, the not-so-distant dark ages for erectile dysfunction, when little was understood about its biological underpinnings, and psychological explanations ruled. Dr. Morgentaler writes that therapists offered “an endless set of psychological causes” to explain erectile dysfunction, from early bedwetting to an unexpected childhood glimpse of people having sex.

Meanwhile, researchers were beginning to understand more about how erections worked, particularly the key role of the “corpora cavernosa,” anatomic structures whose spongy innards hold “‘cavernous’ spaces that are lined with smooth muscle.”

But enough background. Let us jump to 1983 Las Vegas, and a memorable moment in pre-Viagra history…

Keep Your Pants On [Excerpted with permission; all rights reserved.]

Advances in medicine and science do not necessarily move forward in a series of considered steps, with each study adding to our knowledge incrementally. More often than not, science, like evolution, is propelled by major disruptions. In the world of male sexuality, that disruption was caused by an eccentric British neurophysiologist named Giles Brindley, who in 1983 gave a lecture that would change the field forever. Over the years I’ve asked several of my colleagues who attended what it was like, and they all smile and shake their heads in wonder.

Finally, he says, ‘Oh hell,’ or whatever the British equivalent is, and says, ‘I guess I need to demonstrate this for you.’

Recently, at a meeting of the Sexual Medicine Society of North America (yes, such a society really does exist!), I sat down with Irwin Goldstein, MD, accompanied by his wife, Sue, to talk about the shift from the Masters and Johnson psychological model of erections and ED to the physical model that followed. Irwin has been, in my opinion, the single most important figure in the world of sexual medicine over the last thirty years. During that period, wherever and whenever there was something important happening in the field, Irwin was there, often as the leading figure. A high-energy, enthusiastic, irrepressibly cheerful man, Irwin trained dozens of individuals who went on to achieve their own academic prominence. Several years ago he moved to San Diego, where he established the first department of sexual medicine in the country at Alvarado Hospital Medical Center.

“Before Giles Brindley,” explained Irwin, “we knew erection must be controlled somehow by smooth muscle. But we didn’t know whether smooth muscle in the penis caused erections by contracting or relaxing. Actually, the scientific community at the time was divided into two camps: ‘the vascular relaxation camp’ and ‘the vascular contraction camp.’ After Brindley, there was no more discussion. It was settled.”

“Were you there?” I asked.

“Of course,” he replied. “I was one of the speakers on the same program.”

“What happened?”

“It was incredible. Continue reading

Why Has Psychiatric Drug Development Stalled Lately?

colorpills
Just because drug companies get a lot of flak for pushing psychiatric medications, that doesn’t mean anyone wants them to stop developing better ones.

But that is what’s happening: investment in new psychiatric treatments is on the decline, reports Dr. Steven Hyman, former head of the National Institute of Mental Health and now director of the Stanley Center for Psychiatric Research at the Broad Institute. And that decline has hit even though psychiatric drugs have been highly profitable and one in five American adults now takes at least one, he says.

Hyman writes in the latest issue of Cerebrum, the Dana Foundation magazine:

During the past three years the global pharmaceutical industry has significantly decreased its investment in new treatments for depression, bipolar disorder, schizophrenia, and other psychiatric disorders. Some large companies, such as GlaxoSmithKline, have closed their psychiatric laboratories entirely. Others, such as Pfizer, have markedly decreased the size of their research programs. Yet others, such as AstraZeneca, have brought their internal research to a close and are experimenting with external collaborations on a smaller scale.

What’s going on? Read the full article here — a well-written history of attempted progress despite the lack of fundamental understanding of how mental illnesses actually work. And — in keeping with this week’s widespread talk of the new federal brain mapping initiative — Hyman remains optimistic that new scientific advances will bear fruit. He writes:

Our best hope is that the genetics will unfold over the next several years, due to the efforts of large international consortia that have formed to recruit and to study patients. Continue reading

Boston Biolab Clears State Hurdle For Max-Security Work

The National Emerging Infectious Diseases Laboratories, on the BU Medical Campus. Photo by Kalman Zabarsky, courtesy of BU)

The National Emerging Infectious Diseases Laboratories, on the BU Medical Campus. Photo by Kalman Zabarsky, courtesy of BU)

It’s widely referred to as the “needle” — as in NEIDL, the acronym for the National Emerging Infectious Disease Laboratory. It’s a futuristic, seven-story tower near Boston Medical Center in the South End, built to house high-level infectious-disease labs. And its fate has been mired in controversy for years, the kind of struggle you’d expect around a plan to research some of the world’s deadliest pathogens right near a densely populated neighborhood.

BU Today explains: “Construction on the $200 million facility was completed in September 2008, but controversy and litigation have kept much of the building’s 192,000 square feet of laboratory space closed.”

Now, BU Today reports that the NEIDL has just gained a key approval:

The Massachusetts Secretary of Energy and Environmental Affairs has given approval for the lab to conduct research at Biosafety Level 3 (BSL-3) and Biosafety Level 4 (BSL-4). The state agency issued a Massachusetts Environmental Policy Act (MEPA) certificate on Friday, clearing the way for the issuance of final state permits for the project.”

Some background:

As the Globe’s Stepehen Smith wrote in 2010: “South End and Roxbury residents have taken to the streets and the courts to protest the project. While state and federal judges allowed construction on the $200 million project to continue to completion — it includes both a high-security Biosafety Level-4 lab, as well as other research facilities — they mandated further safety reviews before it could open for research.”

WBUR’s Delores Handy took a press tour of the building last year, and officials told her that the NEIDL was probably the safest building in the city, and that the fence around it could stop truck bombs.

NECN’s Peter Howe described “foot-thick reinforced concrete walls, triple microscopic air filtration systems, intensely guarded entrances and exits, doors controlled by iris scanners to allow only authorized scientists and security personnel in to specific floors, and hundreds of surveillance cameras to prevent anyone from trying to sneak deadly biological samples out of the building to create terrorist weapons.”

Critics point out that the building is just off the Southeast Expressway in the densely populated South End. This, they say, is an issue of environmental justice.

But Boston Mayor Thomas Menino told reporters on the tour: “This is about the future. It’s about making sure that we have the tools in our city to do the research and the findings that we need to cure some of these diseases out there.” Continue reading

Plot Thickens In Dispute Over Consciousness In Vegetative Patients

"Brain function in coma, vegetative state, and related disorders". The Lancet Neurology 3 (9): 537–546. | date 2011-11-30 | (Neurowiki via Wikimedia Commons)

“Brain function in coma, vegetative state, and related disorders”. The Lancet Neurology 3 (9): 537–546. | date 2011-11-30 | (Neurowiki via Wikimedia Commons)


In late November, we reported on some striking experiments that suggested there may be shreds of consciousness in patients who appear to be in a long-term “persistent vegetative state.”

Health columnist Judy Foreman wrote:

The recent work by [University of Western Ontario researcher Adrian] Owen, and others, using fMRI brain scanning technology shows that some patients diagnosed as being in a persistent vegetative state may actually have some degree of consciousness and be able to communicate, that is, by sheer thinking, be capable of answering comparatively simple questions such as “are you in pain?”

Owen’s work found signs of consciousness in a seemingly vegetative patient, Scott Routley:

Essentially, Owen trained Routley to answer questions through a kind of game. When he asked Routley to imagine himself playing tennis, a particular part of his brain, the premotor cortex, lit up on the fMRI brain scans “with a very big signal.” (The premotor cortex sends signals to the motor cortex, which actually signals muscles to move.) Routley learned that imagining to play tennis, thus lighting up this part of his brain, meant “yes.”

Now, the plot thickens: New York-based researchers are calling some of Owen’s findings into question — not those MRI scans, but “bedside” brain-wave checks using EEG readings. The Neuroskeptic blog reports on the back-and-forth here beneath the pithy headline “Another Scuffle In The Coma Ward.” It posts an example of the brain-wave data in dispute and explains: Continue reading

‘Why Am I Still Sick?’ New Documentary Explores The Biofilm Question

Never heard of communities of bacteria called biofilms? You have a lot of company. But do you know someone, or are you someone, who just can’t seem to get shed of one mysterious ailment after another, odd constellations of symptoms and infections that just never seem to go completely away?

Film producer Richard Longland argues that we should connect those dots, that biofilms are sickening and even killing many Americans, in a new film called “Why Am I Still Sick?” It will be partially screened tonight at a free Northeastern conference titled “Innovations in Human Health: The Biofilm Question.” Details here.

What are biofilms? From the conference page:

During the last thirty years, medical researchers have identified startling new facts of how bacteria survive in nature, man and beast. We humans depend on biofilm communities, the predominant microbiological life form, but they sometimes work against us by contributing to chronic disease. So how do we keep these life forms in check when they cause chronic wounds? Periodontal infections? Hospital infections?

I heard about the film from Kat Tatlock, who directed the cancer film we featured at a CommonHealth screening last year, “Outside In,” and contributed to this one as well. Some of the film’s claims — that biofilms could be costing America $100 billion annually, for example — trigger my skeptic’s alarm bells; but it’s clear from the experts quoted in the film, scientists at institutions like MIT and the University of Massachusetts, that biofilms — communities of bacteria — are a well-documented phenomenon, and a potentially frightening one.

More Reason To Sleep On It: Sorting Out The Brain’s ‘Inbox’

sleepingkid

Imagine you’re cleaning off your desk. You sort some papers into folders with the relevant labels. Others you red-tag as “urgent” or yellow-tag as “semi-urgent.” Quite a few go directly into the large circular file at your feet, also known as the trash basket.

Turns out, it seems that your brain does something very similar with your memories every night as you sleep.

The journal Nature Neuroscience has just published a special issue on memory, and among its authors is Dr. Robert Stickgold of Beth Israel Deaconess Medical Center and Harvard Medical School, a leading researcher on the role that sleep plays in consolidating memories.

In the past, my layperson’s take-home message from his complex research might have been, “Sleep helps strengthen memories. So if it’s the night before an exam and you have the option of cramming more or sleeping, better to sleep.”

But there’s ever so much more to know, and for researchers to find out — about sleep states beyond REM, about how our brains “tag” some memories for retention and dump others, about how sleep can improve performance overnight — even about why toddlers so desperately need naps.

Our conversation, lightly edited:

You’ve written a sweeping review of years of recent research on what sleep does to memories. How would you sum up for a lay audience what we now know?

I’d start by telling them a true story, which is that about 50 years ago, my father commented to me that when he was in law school studying for an exam, he would stay up late at night reading case after case, and go to sleep with a complete mishmash of cases in his mind. When he woke up the next morning, they had just all been filed away in the right spot. That was 50 years ago, and I can now say, ‘Yes, and now we have an idea how.’

It really does happen while you sleep, and although some of it can happen while you’re awake, especially if you’re consciously working at it, sleep seems to be a time that’s been set aside to make sure that filing gets done, even without your awareness or intent.

So sleep is a time of sorting and discarding memories?

Sleep is doing about five things. Continue reading