Developments in the Approaching World of Gene-Based Personalized Medicine

GoogleNews.com, MiamiHerald.com, McClatchy Newspapers, June 11, 2009, by Robert S. Boyd  —  WASHINGTON – Six years ago, scientists announced the completion of the Human Genome Project, a historic effort to decipher each of the 3 billion letters in the genetic instruction book for our species. A single anonymous male from Buffalo, N.Y. – code name RP11 – provided the bulk of the DNA used for the project.

Now, many thousands more people are contributing DNA samples for a wide array of follow-on studies designed to turn the project’s findings to practical use in health care, genetics and biological research.

Researchers and doctors have opened a new era of “personalized medicine” that seeks to tailor therapies to patients based on their unique genetic makeups and medical histories.

According to the National Cancer Institute, the days are passing when most cancer tumors were thought to be essentially the same and patients got the same drugs.

“We’re not very good at selecting therapies for individual patients,” Dr. Rick Hockett, the chief medical officer of Affymetrix, a genetics firm in Santa Clara, Calif., told a conference on personalized medicine last week in Washington. “Targeted therapy,” he said, can “improve the benefit-risk ratio for patients.”

For example, Hockett said that heart patients who took the popular anti-clotting drug Plavix had a greatly increased risk of serious problems, including death, if they had two tiny mutations in their genes.

Massachusetts General Hospital in Boston and the Memorial Sloan-Kettering Cancer Center in New York have begun to screen lung tumors for genetic abnormalities that could reveal whether a particular treatment is likely to work or should be avoided.

Last year, Dr. Richard Wilson, the director of the Genome Sequencing Center at Washington University in St. Louis, compared 20,000 genes in cancer cells from a woman who died of leukemia with healthy cells also taken from her body. Wilson identified 10 mutations – or genetic mistakes – related to her cancer, including one that blocks chemotherapy drugs from getting inside the cancerous cell.

Other developments in the approaching world of personalized medicine include:

A “Personal Genome Project” led by George Church, a geneticist at Harvard Medical School in Boston, aims to recruit 100,000 people of diverse backgrounds to analyze their genomes and medical histories.

The first 10 participants already have published their personal data – including their pictures, weights and smoking and drinking habits as well as their DNA – on the Internet for anyone to see.

To take part, volunteers donate hair and saliva samples for DNA analysis. So far, 13,000 people have asked to be enrolled. For privacy, their data will be encoded by number, not by individual names.

The goal is to discover which genetic variations are related to which diseases, so that targeted therapies can be designed. According to Church, at least 1,449 genes have been linked to potential illnesses. For instance, a gene called ApoE is associated with a higher risk of Alzheimer’s.

The National Human Genome Research Institute in Bethesda, Md.,has launched a “1000 Genomes Project,” which has started to collect DNA from 1,000 individuals from Africa, Asia and Europe. The goal is to provide much broader and deeper information than the original limited Human Genome Project could.

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“With social media,” Dr. Sands observed, “we can aggregate across space and across the world and create a safe environment for support. Although there may be only 10 people in greater New York with a certain disease, there may be 250 people across the world.”

The New York Times, June 11, 2009, by Pauline W. Chen MD  —  I blog, I tweet and I use Facebook. And as I recently told a medical colleague, social media has been an enormously useful tool in my work.

“I can barely keep up with e-mail,” he snorted back. “I’m not about to open up that black box.”

About 15 years ago, during my residency and just as the first blogs were starting up, I took care of a patient in his mid-40s whom I’ll call Eddie. In a waiting room filled with elderly patients crippled by vascular disease, Eddie looked out of place. Until you looked closer at his fingers and toes. Parts of them had been amputated.

Eddie suffered from Buerger’s disease, or thromboangiitis obliterans, an illness that causes clotting and inflammation of the blood vessels of the hands and feet. Considered an “orphan” disease because of its relative rarity, Buerger’s disease compromises the blood supply to a patient’s fingers and toes. Eventually these patients, who are usually men in their 20s to 40s who smoke, develop excruciating pain, severe ulcerations and gangrene. And more often than not, they must undergo progressively higher amputations.

There is no cure for Buerger’s disease; the only way to slow the process is to quit smoking. Therein lies the tragedy. For unknown reasons, patients who suffer from Buerger’s disease are profoundly addicted to tobacco, far more so than most smokers. It is nearly impossible for them to quit.

Eddie wanted desperately to quit. Over the two years that I cared for him, he tried at least a dozen times. But his already challenging task was made even more difficult by his isolation. Eddie lived alone, estranged from his family, with friends and co-workers who grew increasingly unsympathetic to his plight. “They don’t understand why I keep smoking if I keep losing fingers,” he said to me one afternoon. “They just don’t understand how hard it is for me.” Moreover, because his disease was so rare, he had no community of fellow patients to turn to in his town or at our hospital.

But his visits to the clinic always seemed to cheer him up. He responded, it seemed, to my encouragement, and each time he left, he renewed his vow to quit smoking. But weeks would pass and his enthusiasm would wane. If I contacted him by phone, his momentum might continue another few days, but finding a mutually convenient, quiet moment to talk on a regular basis was exceedingly difficult. I tried scheduling frequent follow-up appointments, but Eddie lived over an hour away from our hospital and could not afford to keep missing work.

Eventually, Eddie lost another two fingers, the front half of his left foot and his entire right foot. The youngest man in my waiting room soon became confined to a wheelchair. At the end of our last visit, I stood in the clinic hall watching him inch away from me in that chair, pushing off the ground with the remaining stump of his left foot and grasping at the wheels with hands that had become mitts.

I thought about Eddie and other patients I have cared for who might have benefited from more frequent contact when I spoke with my colleague about social media and the patient-doctor relationship. I wondered if Eddie would have felt a little less isolated and perhaps been able to quit smoking if I had, for example, texted a word of encouragement to him every few days, interacted through blog comments, or directed him to an online community of people who were dealing with the exact same disease.

A survey released today by the Pew Internet and American Life Project reports that 61 percent of Americans go online for health information, and the majority of them have turned to user-generated health information. But a quick scan through peer-reviewed journals reveals only a handful of articles, and no evidence-based guidelines, to guide doctors on the use of social media. It is unclear whether such engagement adds to or detracts from a therapeutic patient-doctor relationship, and clinicians are unsure about what constitutes good standards of care and professional responsibility on these platforms. For example, should doctors give out diagnoses or prescribe treatment on Facebook or a blog? If doctors and patients communicate on Twitter, is a doctor liable if she or he misses a patient’s tweets about the acute onset of shortness of breath?

Dr. Sean Khozin, who blogs and can be found on Twitter @SeanKhozin, is an internist and founding member of Hello Health, a paperless “concierge” practice based in Brooklyn that utilizes e-mail, instant messaging and video chat for coordinating care. “There are so many layers of bureaucracy between health care providers and patients,” Dr. Khozin said. “We can use social media to coordinate care with patients and with different specialists, all using the same platform. I can monitor my patients, and they can also use these tools to become empowered through a better understanding of their own disease state and active engagement.”

In Dr. Khozin’s practice, that engagement occurs on a secure site, as patient privacy remains a major concern with all forms of social media. But on platforms such as Twitter and Facebook, where privacy is more difficult to insure, those concerns also extend to physicians. “On the one hand it is really good to see the human side of your doctor on a site like Facebook,” observed Dr. Daniel Sands (@DrDannySands), a physician at Beth Israel Deaconess Medical Center in Boston, Mass., and a consultant with the Cisco Internet Business Solutions Group, as well as co-author of the first set of guidelines ever published on using e-mail in patient care. “On the other hand,” Dr. Sands continued, “maybe letting your patient get too close isn’t always good for the therapeutic relationship.”

Taking on the responsibilities of yet another form of communication can also be onerous for physicians, many of whom already feel overburdened by multiple demands on their time. “Physicians are really busy,” Dr. Sands said. “In our current health care environment, the only commodity they have is time. Doctors don’t want to introduce new technologies of unknown value, which is why many were hesitant about e-mail. Something like Twitter is going to take longer to accept because the value proposition is even hazier.”

Still, there continues to be anecdotal evidence regarding social media’s potential to strengthen the patient-doctor bond. “One way I see that power is through education,” said Dr. Christian Sinclair, a physician for Kansas City Hospice who has created a palliative care network through his blog and Twitter (@ctsinclair). “I can help to inform the public, I can put the knowledge I have out there. And if there are patients or families who need this knowledge, I can help them because of this network.” Dr. Sinclair has, for example, helped individuals he has met through Twitter connect with local hospices, a process he believes was expedited by Twitter’s particular platform.

And social media can also help patients and physicians widen illness support networks, which in turn can augment the patient-doctor relationship. Health care providers have long known that patients with chronic or life-threatening diseases benefit from support groups made up of people who can sympathize and empathize with them. But such support is difficult for physicians or hospitals and clinics to cobble together when patients and families are physically isolated or homebound, or when they have an orphan disease like Eddie’s.

“With social media,” Dr. Sands observed, “we can aggregate across space and across the world and create a safe environment for support. Although there may be only 10 people in greater New York with a certain disease, there may be 250 people across the world.” Dr. Sands recalled guiding a patient to the Association of Cancer Online Resources, a social network of online communities for patients and families. “That was the most important advice I ever gave him. It was an information prescription.”

Social media platforms can turn 10- or 20-minute doctor’s visits into an ongoing dialogue, where sources of information and, potentially, support are continually available to the patient and the doctor. “Platforms like Twitter can be powerful if doctors are a lot more active in disseminating their expertise,” Dr. Khozin said. “Patients are being bombarded with information online, but I don’t think all that information necessarily empowers them. You also need expertise.”

Social media has kept me connected with colleagues and a few former patients, allowed me to stay up-to-date with certain health care and medical education issues, and helped me to keep abreast of Web-based resources that might be useful to those I care for. It has also taught me a tremendous amount about the experiences of patients and caregivers, information I’m not sure I would have had access to had I not been engaged online. Although I am far from a savvy user, I have come to think of social media like I do any other test, instrument or procedure; it’s extremely helpful in some situations, and for some patients, and less so in others.

A few days ago, staring at a blank screen and thinking about this column, I tweeted: Working on column on social media (spec. Twitter, Facebook, blogs) and patient-doctor relationship. Any opinions?

Minutes later I began to receive replies, including this one from @achronicdose:

Knowledge from patient-peers thru social media *can* mean more helpful talks w/ dr; dr. p.o.v. helpful for patients to read.

Doctor or patient, you are never alone in the twitterverse or blogosphere; there is always someone who is willing to offer some help or lend some support. It’s a world that I think might have made all the difference for a patient like Eddie.

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Mathieu Belanger for The New York Times

Charles Morin, a psychology professor at Laval University in Quebec, in a study chamber of his sleep clinic.

HOW much would you pay for a good night’s sleep?

The New York Times, June 10, 2009, by Lesley Alderman  —  If the sleep peddlers have their way, quite a bit. Sleep is a $23.9 billion industry – if you count things as diverse as mattresses, white noise machines and prescription pills – and it has more than doubled in the last decade, according to Marketdata Enterprises, a research firm in Tampa, Fla.

The market for insomnia drugs alone is expected to grow 78 percent, to nearly $3.9 billion, by 2012, as drug makers scramble to bring more pills to market to compete with name brands like Lunesta, Sonata and Ambien CR.

There is even a new event, the National Sleep Foundation’s Big Sleep Show, to promote sleep-inducing products and services to the tired masses. It occurs several times a year, and the next one is set for August in Dallas.

Sleeping is a serious problem for millions of people. The National Sleep Foundation (which receives financial support from pharmaceutical companies) estimates that 20 percent of Americans, up from 13 percent eight years ago, sleep fewer than six hours a night. The lucky few who sleep a full eight hours or more dropped to 28 percent, from 38 percent, the foundation said.

Being chronically sleep-deprived is more than just tiring. It can lead to depression, high blood pressure and lower productivity, both on and off the job.

If the problem is pure insomnia – rather than sleep apnea or another medical issue – there are smart and affordable options. Here are some of the most cost-effective ways to get the sleep you need, and a few things you should avoid altogether.

Patient Money You have probably heard these sleep dos and don’ts before, but they bear repeating. If you have been tossing and turning, do not drink caffeine after, say, 2 p.m. And avoid downing more than a glass of wine or the equivalent amount of other alcohol in the evening.

Save stressful activities, like arguments with your children or a review of your finances, for early in the day.

Get into bed a half-hour before you plan to turn out the lights, and read a calming book. No TV, BlackBerry or electronic diversion of any kind an hour or so before bed, because they tend to be stimulating, not relaxing.

Exercise regularly, and reduce the overall level of stress in your life. (Free, yes. Easy? Not always.)

For more tips and suggestion, try the consumer site (www.sleepeducation.com) of the American Academy of Sleep Medicine.

Do not waste your money on herbs like Valerian or fancy mattresses. There is no proof that herbs or special bedding help chronic insomnia.

Over-the-counter medications that contain sleep-inducing antihistamines are fine for a night or two, but that is all. They typically do not work over the long term, and they bring unpleasant side effects like dry mouth and grogginess, says Dr. Alex Chediak, a past president of the American Academy of Sleep Medicine and an associate professor of medicine at the University of Miami.

If you still cannot sleep, see a doctor.

FIND A SLEEP SPECIALIST If you have mild insomnia, see your primary care physician. But if you have been having trouble sleeping for months and feel tired most days, Dr. Chediak advises finding a board-certified sleep doctor.

Doctors with that certification – there are about 3,500 in this country – have passed a rigorous exam and have a thorough knowledge of sleep medicine. Your physician can give you a referral or you can go to the American Board of Sleep Medicine’s sleep center site (www.sleepcenters.org). All accredited sleep centers are required to have one certified sleep doctor on staff.

A sleep doctor will first try to rule out an underlying medical condition that would require treatment by a different type of specialist. If you have primary insomnia, a medical condition in its own right, your doctor will probably begin treating you right away.

TRY A GENERIC DRUG Your doctor may prescribe a so-called hypnotic drug to help you sleep through the night. Ask for a generic option- such as zolpidem, the generic version of Ambien – which will be much cheaper than brand-name medications like Ambien CR or Lunesta, which can cost $2 to $3 a pill.

If your main problem is falling asleep in the first place, zolpidem is very effective and works quickly, Dr. Chediak says. But if your problem is waking too early, he might suggest a longer-duration drug like temazepam, the generic version of Restoril.

CONSIDER A NONDRUG OPTION When your insomnia is chronic, meaning it has been going on for months, your doctor might also recommend cognitive behavioral therapy, or C.B.T.

C.B.T. for insomnia is meant to help patients change the behaviors and thoughts that can get in the way of a good night’s sleep. Proponents say that it is remarkably effective and that once you learn it you may never have to spend a dime on medications again.

The cognitive part of the process teaches you to change anxiety-producing thoughts that interfere with your ability to sleep, says Gregg Jacobs, who has a doctorate in behavioral medicine and is an insomnia specialist at the Sleep Disorders Center at UMass Memorial Medical Center in Worcester, Mass. You might lie awake worrying, “I have to get eight hours of sleep or I will be a wreck tomorrow.” Most people, however, can function fine on seven hours, he says.

The behavioral part aims at actions that impair your ability to sleep, like spending too much time in bed or not exercising at all during the day.

“C.B.T. should be the first-line therapy for people with chronic insomnia,” says Dr. John Winkelman, medical director of the Sleep Health Center at Brigham and Women’s Hospital in Boston, and a consultant to several pharmaceutical companies. “It’s fabulous.”

It typically takes about four to five sessions over six weeks to learn the therapy and reap the benefits. A study published in the May 20 issue of The Journal of the American Medical Association looked at the effectiveness of behavioral therapy alone and therapy in conjunction with zolpidem. The study found that patients who used both therapy and zolpidem fared better during the first six weeks of the study. But by the six-month mark, subjects who relied on behavioral therapy alone made the most progress.

“In the short run, medication is helpful,” said the study’s primary author, Charles Morin, a professor of psychology at Laval University in Quebec. “But in the long run, people need to change their actual sleep habits – that’s what C.B.T. helps them do.”

Your sleep doctor may be able to do the therapy with you or may refer you to a psychologist who is trained in behavioral sleep medicine. If your insurer covers your visits, you will have only a co-payment. If it does not, it may cost $100 to $150 a session. You can also learn cognitive behavioral therapy online at www.cbtforinsomnia.com for a $25 fee. The program was designed by Mr. Jacobs of the Sleep Disorders Center.

While in-person therapy is usually preferable, a study published in the current issue of the journal Sleep found that 81 percent of 118 subjects who used online behavioral therapy reported improved sleep.

Check with your doctor before trying an online behavioral therapy program. It may not be helpful for people with certain conditions like depression, anxiety or bipolar disorder, for example.

STICK WITH IT “The most wasteful thing is not doing anything,” Dr. Winkelman said. “The cost of living with insomnia can be far more than the cost of treating it.”

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ScienceInSociety.Northwestern.edu, Spring 2009, by Aimee Schultz, Todd Kuiken  —  A procedure called “targeted reinnervation” reroutes brain signals from nerves severed during amputation to intact muscles, allowing patients to control their protheses intuitively. The map above plots a patient’s attempt to move his missing limb.

Over the last few decades, we have seen robots created with astonishing capabilities-a humanoid robot that can walk up and down stairs, a robot that can rove on Mars, collect samples, and send images back to Earth, and robots that are used to help perform surgery. With all the amazing robotic technology that surrounds us, one might wonder why prosthetic limbs (used to replace human arms and legs) aren’t more like the real thing.

In fact, many amazing advancements in prosthetic technology have been made in recent years, with more currently underway. Unfortunately, prosthetic limbs still haven’t reached the level of Luke Skywalker’s flawless arm in Star Wars. Why? One reason is that we lack ways for people to naturally and intuitively tell their prosthetic limbs what to do.

In general, robots are either controlled through remote control or programmed to perform certain tasks at a given time. A prosthetic limb, however, cannot be preprogrammed- how could we know when someone would want to take a drink of water, or begin to walk up the stairs? And a remote control would take a great amount of concentration as well as the constant use of one or both hands.

There are two ways in which prosthetic arms are currently controlled. One way is to use other body motions, such as shrugging the shoulders, to pull on a series of cables and operate the hand, wrist, or elbow. These prostheses are called “body-powered” prostheses. The other way is to read the tiny electrical signals generated by muscles when they contract, and use these signals from remaining muscles to control a motorized arm.

These muscle signals are read by small electrical antennas called electrodes. For example, someone who has lost their arm above the elbow may use their biceps and triceps muscles to control their prosthetic hand. The prosthesis could be programmed to interpret signals from the biceps muscle as “open the hand” and signals from the triceps muscle as “close the hand.” These prostheses are called “myoelectric prostheses.”

Designers of myoelectric prostheses have an important problem to solve-there are many movements to control, and not enough remaining muscles to control them. Take the example above: if the biceps and triceps muscles are used to open and close the hand, what muscles can send the signals to bend and straighten the elbow? And what if the hand needs to rotate sideways in order to pick up an object-how will the user tell it to do this?

Researchers have tried many ways to get around these issues. They have implemented various types of switches, or instructed users to perform combinations of muscle contractions to act as a switch. However, the lack of available control signals makes it extremely difficult to move prosthetic limb technology forward.

The Neural Engineering Center for Artificial Limbs at the Rehabilitation Institute of Chicago is focused on this problem of prosthesis control. The lab centers around a surgical technique called targeted muscle reinnervation (TMR). The goal of TMR surgery is to utilize to the brain commands that still attempt to reach the missing limb. These commands travel down nerves that were severed during amputation and are no longer received by muscles. If these nerves are connected to different muscle sites, they can cause these other muscles to contract, producing the signals used to control myoelectric prostheses.

The first TMR patient was a man who lost both arms at the shoulder in an electrical accident. Without arms, his chest muscles were useless to him. So, on his left side, they cut the nerves which ran to the chest muscles and instead connected the nerves which had previously gone to his arm.

After a few months, attempts to move his missing left arm resulted in contractions of his chest muscles, with different contractions occurring for elbow bending, elbow straightening, hand opening and hand closing. Then, using an even larger number of surface electrodes to read the muscle contractions, researchers were eventually able to tell the difference between attempted movements of the elbow, wrist and hand, including different types of hand grasps. Not only did this help with the problem of control, letting the patient independently move different joints, but it allowed him to control his prosthesis intuitively. His attempts to move his missing arm now resulted in similar movements of the prosthesis.

Work is now underway to further refine myoelectric control. Rather than using individual muscle sites to control each movement, a computer can be trained to recognize different movements from the pattern of electrical signals recorded from all reinnervated muscles. It does not require the muscle signals to be perfectly isolated, and can adapt to extra signals, such as a heartbeat. In addition, the placement of electrodes is not required to be exact, as they would with conventional control, because the system is retrained each time the system is used. This technology, called “pattern recognition,” is currently only used as a research tool. However, it’s possible that it could one day be incorporated into prosthetic devices for even more precise control.

Further improvement of prosthetic technology may be possible because of an additional and unexpected result of TMR surgery. Several months after his procedure, the first TMR patient reported that being touched on his chest actually felt like he was being touched on his missing arm-the sensation nerves had grown into his chest skin. Further investigation has shown that patients are able to perceive different temperatures, sharpness of objects, vibrations, and pressures on their reinnervated skin, and that they feel like all of these stimuli are being applied to their missing limb.

Researchers have been able to “map” these perceptions, or see what locations on the reinnervated skin correspond to the pinky finger, palm, forearm, etc. Surprisingly, these maps appear to remain stable over time. By learning more about these perceptions, we hope to someday provide feedback from the prosthesis to the reinnervated skin that will allow users to “feel” with their artificial arm as if it were their own hand. This could go a long way in improving patients’ ability to control their prostheses, and even improve their quality of life.

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BBC.co.uk, June 11, 2009  —  The World Health Organization (WHO) has declared a global flu pandemic after holding an emergency meeting, according to reports.

It means the swine flu virus is spreading in at least two regions of the world with rising cases being seen in the UK, Australia, Japan and Chile.

The move does not necessarily mean the virus is causing more severe illness or more deaths.

The swine flu (H1N1) virus first emerged in Mexico in April.

It has since spread to 74 countries.

Official reports say there have been 28,000 cases globally and 141 deaths and figures are rising daily.

Hong Kong said it was closing all its nurseries and primary schools for two weeks following 12 school cases.

It is the first flu pandemic in 40 years – the last in 1968 with Hong Kong flu killed about one million people.

The current pandemic seems to be moderate and causing mild illness in most people.

One factor which may have prompted the move to a level six pandemic was that in the southern hemisphere, the virus seems to be crowding out normal seasonal influenza.

It is thought the move was not prompted by the situation in any one country but the reports of several pockets of community spread.

The BBC’s Imogen Foulkes, in Geneva, says that while the number of cases has made the declaration inevitable, the problem is that the pandemic phase system is designed for a very different type of virus.

WHO spokesman Gregory Hartl said it had been expecting something more like the deadlier bird flu.

“It was believed that the next pandemic would be something like H5N1 bird flu, where you were seeing really high death rates, and so there were people who believed we might be in a kind of apocalyptic situation and what we’re really seeing now with H1N1 is that in most cases the disease is self-limiting,” he told the BBC.

The WHO will have to manage the global anxiety the declaration of a pandemic will generate, our correspondent says.

Pandemic planning

There have been more than 800 cases in the UK with some areas of Scotland being particularly hard hit.

The government has been stockpiling antivirals such as Tamiflu and has ordered vaccine, some doses of which could be available by October.

Chief medical officer, Sir Liam Donaldson said the WHO declaration of a pandemic would not significantly change the way the UK was dealing with swine flu at the moment.

But he added there could be some minor changes to who received antivirals.

“The declaration of a pandemic per se doesn’t make a big difference to the to the way we are handling the outbreaks we have.

“We are going to continue to investigate every case that occurs and treat their contacts with antivirals even though they may not be ill.

“The difference is that the Health Protection Agency has learnt a lot about approaching this question of antiviral prophylaxis and they are going to be treating the closer contacts of the cases, rather than the more far-flung contacts, because they feel that that is supported by what they know so far about how the disease is transmitting.

He added: “These flu viruses can change their pattern of attack, so when we come into the flu season in the autumn and winter in this country, when we expect a big surge of cases, we need to watch very carefully to see if the character of the virus is changing.”

Scottish health secretary Nicola Sturgeon said a move to level six means that countries need to be ready to implement pandemic plans immediately but the UK was already operating at a “heightened state of readiness”.

But it could affect the speed at which the UK gets pandemic vaccine supplies but that had been factored into pandemic planning.

Flu expert Professor John Oxford, said people should not panic as the outbreak was milder than others seen in the past century.

“It is global and fulfilling the requirements of a pandemic but I don’t think anyone should worry because nothing drastic has happened between yesterday and today.”

Social Networking for Seniors

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Carla Winn for The New York Times

Paula Rice, 72, of Island City, Ky., spends many hours a day conversing with friends online.

The New York Times, June 11, 2009  —  About one-third of people ages 75 and older live alone, and increasingly they are turning to online social networks like Facebook and MySpace for support and companionship, reports Stephanie Clifford in Tuesday’s Science Times. Online networks can provide benefits similar to those of real-world groups of friends, but often are easier to assemble and maintain, experts say.

“One of the greatest challenges or losses that we face as older adults, frankly, is not about our health, but it’s actually about our social network deteriorating on us, because our friends get sick, our spouse passes away, friends pass away, or we move,” Joseph F. Coughlin, director of the AgeLab at the Massachusetts Institute of Technology, told Ms. Clifford.

“The new future of old age is about staying in society, staying in the workplace and staying very connected,” he added. “And technology is going to be a very big part of that, because the new reality is, increasingly, a virtual reality. It provides a way to make new connections, new friends and new senses of purpose.”

About The New Old Age

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population, and most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children, 77 million strong, who are flummoxed by the technicalities of eldercare, turned upside down by the changed architecture of their families, struggling to balance work and caregiving, and depleting their own retirement savings in the process. In The New Old Age, we explore this unprecedented intergenerational challenge.

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Brandon Thibodeaux for The New York Times 

The New York Times, June 11, 2009, by Anne Underwood  — Bob Branham, 78, at home with some of his quilting projects. He participates in a study designed to see whether acquiring new skills can stave off dementia.

At the age of 78, Bob Branham, a retired computer software developer in Dallas, Tex., took up quilting. It wasn’t his idea, actually. He’d never dreamed of piecing together his own Amish diamond coverlet or rummaging around Jo-Ann Fabrics in search of calico prints. But then he enrolled in a trial sponsored by the National Institute on Aging to assess whether learning a new skill can help preserve cognitive function in old age. By random assignment, he landed in the quilting group.

When it comes to mental agility, we’re more likely to think of crosswords than cross-stitch. But neuroscientists suspect that learning a challenging new skill – a new language, a new musical instrument – may be even more effective than mental games at keeping the brain sharp. And quilting is more complicated than it may seem.

“It’s a very abstract task,” said Dr. Denise Park, a cognitive neuroscientist at the University of Texas at Dallas, who is leading the trial. “You have to picture what the pattern will look like, match fabrics, manipulate geometric forms, mentally rotate objects.”

In Mr. Branham’s case, he also had to learn to use a sewing machine. And while it’s too early to tell if quilting is sharpening his mind, he quickly found that he loved his new pastime. He spends as much as 40 hours a week piecing and stitching, both at home and at the social center that Dr. Park set up for the trial.

“I get ideas and pointers from the instructor and the other participants,” he said. “We have a real good time.”

Memory is among the least understood areas of neuroscience, and the sad truth is that there is no magic pill or potion at present that will prevent our parents’ minds from failing. But a panel of 30 experts from the United States and Europe recently issued a consensus statement on what we do know about maintaining brain fitness (which includes not only memory, but also reasoning, attention and speed of processing). The verdict was that three things are crucial: physical exercise, mental challenges and good health habits in general.

But wait! What about the supplements and software programs we’ve been stocking up on? “There’s a lot of snake oil out there,” warned Dr. Laura Carstensen, director of the Center on Longevity at Stanford University, who co-chaired the panel. In short, don’t count on supplements. (The rationale behind ginkgo biloba is plausible, but there is no scientific evidence it works.) Steer clear of anything that promises to prevent Alzheimer’s disease. (Such a claim would require approval from the Food and Drug Administration, and no product has it.) And look skeptically on software programs. (Most improve performance only on the games themselves, not mental function in general.)

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Brandon Thibodeaux for The New York Times

Instead, Dr. Carstensen said, get moving. Exercise may sound like an impractical way to boost Mom’s cognition when her energy levels are dwindling. But multiple studies show it helps. In a study published in the Archives of Internal Medicine in 2001, women ages 65 and older who walked the most showed the least cognitive decline over an eight-year period – up to 30 percent less than their sedentary counterparts.

Another trial in the journal Nature by Dr. Arthur Kramer, a neuroscientist at the University of Illinois at Urbana-Champaign, found not just slower declines but actual improvements in working memory, attention and executive skills in older adults (average age 72) after six months of an aerobic exercise program – specifically, 45 minutes to an hour of walking, three times a week.

How could aerobic exercise possibly accomplish this? Among other things, it increases blood flow, encourages the formation of new synapses and reverses some of the age-related decline in brain volume. “If exercise were a pill, it would be the most expensive drug on the market,” said Dr. Carstensen.

Other good habits are important, too. As neuroscientists like to say, what’s good for the heart is good for the brain. That would include maintaining healthy blood sugar and blood pressure levels. A study last December in the Annals of Neurology showed that controlling blood sugar, even in non-diabetic adults, can help prevent deterioration in a part of the brain that’s necessary for memory formation. Another paper published in the Archives of Neurology in February by scientists at Columbia University found that eating a heart-healthy Mediterranean diet – rich in fish, vegetables, whole grains, fruits, legumes and unsaturated fats – lowered the risk of mild cognitive impairment over four and a half years by as much as 28 percent.

But even if Mom follows all the advice she herself used to propound – eat your vegetables, go outside and exercise – there is no substitute for mental challenges. The brain is a use-it-or-lose-it type of organ. Synaptic connections that aren’t firing will weaken.

The problem with most of our favorite approaches to staying sharp is that they are narrowly focused when what’s needed is global improvement. Crosswords are great for word retrieval. That’s clearly important. But not even The Times’s Sunday puzzle by Will Shortz will help you remember where you left your car keys. “If you want lots of improvement, you have to do mental cross-training,” said Dr. K. Warner Schaie, a professor of psychology at Pennsylvania State University.

In short, engage in many types of mental activity. Do crosswords, Sudoku, acrostics, play bridge, read books, join clubs, get into debates, volunteer – anything to keep the mind alive and engaged in new and interesting tasks. If the activity includes social interaction, so much the better. Or take up a new hobby, a new language or a new instrument that will challenge the brain in entirely different ways, preferably for years. “One problem with aging is that you develop expertise in a few things and do them over and over,” said Dr. Carstensen. “Proficiency is good, but it’s probably not growing new synapses.”

Mr. Branham, on the other hand, seems to be sprouting plenty of neural connections. He’s now completed two full-sized quilts – one a sampler with various patterns, the other a split rail design with stars in the four corners. He’d even like to launch a small business selling his patchwork place mats and table runners. When friends at church ask him why he signed up for such a study, and why on earth he agreed to start quilting, he has a ready answer. “Studies need participants,” he says. “And you should sign up, too.”