Category Archives: healthy habits

healthy habits, nutrition, policy, rapid learning health systems

Katz in the SMH

Good to see Dr Katz in the SMH

http://www.smh.com.au/lifestyle/diet-and-fitness/blogs/chew-on-this/do-you-need-tastebud-rehab-20140501-37k6a.html

Do you need tastebud rehab?

Date: May 5, 2014 – 8:03AM
Paula Goodyer is a Walkley award winning health writer

View more entries from Chew on This

Illustration: Judy Green.

Illustration: Judy Green.

On the face of it the cause of weight gain is simple: we eat too many kilojoules. What’s less simple is fixing the reasons that encourage overeating – a complex mix of factors like the need for comfort, the power of food marketing and inflated portion sizes, none of which have anything to do with hunger.

On top of this is a food supply loaded with amped up flavours that make it easy to overeat. Traditional foods that used to be simple now come with extra layers of flavour and kilojoules – plain yoghurt has been almost kicked out of the chiller cabinet by sweetened yoghurt; scones and hot cross buns come flavoured with chocolate, there’s pizza made, not just with cheese and ham, but ham and bacon and peperoni and barbecue sauce – and we’re embellishing a cup of coffee with caramel syrup.

“What was once a survival advantage in an age when the only sweet foods were breast milk, honey and fruit makes us easy targets for an industry flogging food with more-ish flavours.” 

It’s what Dr David Katz, director of Yale University’s Yale-Griffin Prevention Research Centre in the US, calls the hidden challenge to eating well in the modern world.

This over-flavouring of food can be hard on the waistline, says Katz, explaining that we’re  hardwired to crave sugar and salt, a hangover from our hunter gatherer days when sweet, salty or fatty foods were hard to find but important for survival in a time when the food supply was unpredictable. But what was once a survival advantage in an age when the only sweet foods were breast milk, honey and fruit makes us easy targets for an industry flogging food with more-ish flavours.

“Manufacturers of processed foods are counting on this,” Katz says. “Their goal is nothing short of wanting to profit from our inability to control ourselves when their irresistible food product is in our hands.”

We’re not entirely helpless though. Reliance on very sweet and salty flavours is reversible and inDisease Proof, a new book that provides practical skills for preventing chronic disease, Katz  devotes a chapter to  retraining overstimulated taste buds so that we can appreciate the natural flavours of healthier foods, widen our food preferences and tame food cravings.

It starts with cutting down on added salt and sugar by reducing reliance on processed foods. Making foods like pasta sauce or salad dressing at home rather than buying them off the shelf, for example, gives us more control over the ingredients and flavours we consume. It also helps to get to know the different names that sugar hides under on the labels of packaged foods such as sucrose, fructose, maltose and lactose.  (Katz also fires a shot at one sweetener with a health halo – agave syrup which he describes as a highly concentrated source of fructose with little, if any, health benefits even though it’s promoted as a healthier option to sugar.)

“Your taste buds will adjust to lower thresholds of these flavours, feeling satisfied with lower amounts of sugar, salt and fat,” he says. “Over time, the sweet and salty flavours you used to eat by the handful may taste too sweet or salty.”

As for food cravings, these are less likely if you eat healthy meals and snacks at regular intervals to keep hunger under control, says Katz who also points out that – like nicotine cravings – a food craving will often pass if you can wait it out for a few minutes.

“Research from the University of Exeter in the UK found that a 15 minute brisk walk reduced urges for chocolate among regular chocolate eaters. If you must give in to a craving, have a small portion, then wait. Researchers at Cornell University recently found that hedonic hunger (eating for pleasure) is satisfied by a handful of a tasty food and tends to disappear after 15 minutes so long as the memory of indulgence remains,” he adds.

It’s also possible to tame cravings with healthier foods – if you want something sweet, try something naturally high in sugar like fruit, or try turning the sweet craving off by eating something with a sour or palate cleansing flavour like citrus or mint.

Speaking of sour flavours, Katz also points out that some of the healthiest foods on the planet – like kale, grapefruit, spinach and plain yoghurt have a naturally bitter flavour and if we shun them we miss out on their benefits.  His tips for making them easier on the tastebuds: sweetening the flavour of Brussels sprouts or broccoli by roasting them with a little olive oil to bring out the natural sugars in these vegetables; serving sautéed kale with a little balsamic vinegar and mixing berries and a dash of vanilla extract into plain Greek yoghurt.

Disease Proof by David Katz is published by Penguin, $29.99

data saving lives, entrepreneurship, healthcare, healthy habits, nutrition, quantified self, rapid learning health systems

Digital Therapeutics – Omada Health

The world is finally entering a new era of effective, scalable, and life-saving change, all delivered through the other end of an internet connection. For three out of four of us, that change can’t come soon enough.

http://www.forbes.com/sites/sciencebiz/2014/04/17/what-if-doctors-could-finally-prescribe-behavior-change/

BUSINESS 4/17/2014 @ 5:31PM |3,232 views

What If Doctors Could Finally Prescribe Behavior Change?

This guest article is by Sean Duffy, CEO and Co-Founder, Omada Health

Three out of four Americans will die of a disease that could be avoided—if only they could re-route their unhealthy habits. A new category of medicine, digital therapeutics, wants to change the course of these conditions — and of history.

Doctors have known for decades that, in order to prevent disease or its complications, they were going to have to get into people’s living rooms and convince them to change everyday behaviors that would very likely kill them. To that end, back in the early ’90s, health institutions started trying to intervene largely via the cutting-edge technology that existed at the time: phone calls. At-risk populations were dialed up and encouraged to take steps that could ward off heart disease, diabetes complications, lung cancer and other avoidable conditions that cause 75% of Americans to die prematurely.

As you can imagine, these calls largely flopped. A phone interaction led by a stranger who interrupts your dinner hour, no matter how well-intentioned, felt like more like an intrusion than meaningful
support.

The more we discover about behavioral science, the more naïve those calls seem in retrospect. Whether it’s for weight loss, smoking cessation, diabetes, or otherwise, the best research shows that meaningful behavior change outcomes require not just guidance from a trusted health professional, but also positive social support, easy-to-digest insights about their condition, a carefully orchestrated timeline, and a process that follows validated behavioral science protocols. That’s hard to squeeze into a phone call. Or a doctor’s visit, for that matter.

The world urgently needs better ways to bring behavior change therapies to the masses, and advancements in digital tech are finally enabling us to orchestrate the necessary ingredients to make that happen in a clinically meaningful way.

That’s doesn’t make it easy. In fact, it’s effectively pioneering a new class of medicine, often dubbed “digital therapeutics.” But any clinically-meaningful digital therapeutic needs to clear two significant
hurdles. One, it needs to genuinely engage and inspire the patient, both initially and over time. Two, it must also unequivocally demonstrate efficacy to the medical community by rooting itself in the best science and by producing clinically-significant outcomes, just as any traditional drug is expected to do.

That’s why, until recently, most available health apps couldn’t truly be categorized as digital therapeutics. For instance, a study in 2012 showed that very few of the top 50 smoking cessation apps available at the time abided by evidence-based protocols. This high-tech snake oil was not deliberate, but it is a side effect of the fact that very few of the leading behavioral science researchers knowing how to program in Objective C or Ruby on Rails. Companies looking to truly pioneer in this new category must both establish and exceed the highest scientific standards while building exceptional online experiences. The good news is that is starting to happen.

Emerging in the white hat category are a handful of medically-minded visionaries who have put real clinical rigor into every aspect of their design. For instance, David Van Sickle, a former CDC “epidemiologist intelligence officer,” and now the CEO and Co-Founder of Propeller Health, built a GPS-enabled sensor for asthma inhalers that links to an elegantly designed app — every puff is mapped and time-stamped, allowing patients and doctors to spot patterns in ‘random’ attacks and identify previously unknown triggers.

Another example is Jenna Tregarthen, a PhD candidate in clinical psychology and eating disorder specialist. She rallied a team of engineers, entrepreneurs, and fellow psychologists to develop Recovery Record, a digital therapy that helps patients gain control over their eating disorder by enabling them to self-monitor for destructive thoughts or actions, follow meal plans, achieve behavior goals, and message a therapist instantly when they need support.

Momentum for the promise of digital therapeutics is building. A massive surge in digital health investing reflects how rapidly confidence in this space is growing. In ten years, we have no doubt that your doctor will recommend a digital program for your depression either instead of, or in addition to, a pill. Your insomnia, kidney stones, or lower back pain might be treated by an experience centered around an iOS app. We can clearly see a future where a doctor’s prescription sends you to an immersive online experience as often as it does to a pharmacy.

The world is finally entering a new era of effective, scalable, and life-saving change, all delivered through the other end of an internet connection. For three out of four of us, that change can’t come soon enough.

 

data saving lives, entrepreneurship, facts & data points, health market quality, healthcare, healthy habits, nutrition, policy, politics, quantified self, rapid learning health systems, research methodology

RWJF Report: Personal Data for the Public Good

Solid report on personal health data. Interesting observation re. (lack of) alignment between research and business objectives… i.e. public vs private goods?

http://www.rwjf.org/en/research-publications/find-rwjf-research/2014/03/personal-data-for-the-public-good.html

Report: http://www.rwjf.org/content/dam/farm/reports/reports/2014/rwjf411080

PDF:

1. Executive Summary
Individuals are tracking a variety of health-related data via a growing number of wearable devices and smartphone apps. More and more data relevant to health are also being captured passively as people communicate with one another on social networks, shop, work, or do any number of activities that leave “digital footprints.”
Almost all of these forms of “personal health data” (PHD) are outside of the mainstream of traditional health care, public health or health research. Medical, behavioral, social and public health research still largely rely on traditional sources of health data such as those collected in clinical trials, sifting through electronic medical records, or conducting periodic surveys.
Self-tracking data can provide better measures of everyday behavior and lifestyle and can fill in gaps in more traditional clinical data collection, giving us a more complete picture of health. With support from the Robert Wood Johnson Foundation, the Health Data Exploration (HDE) project conducted a study to better understand the barriers to using personal health data in research from the individuals who track the data about their own personal health, the companies that market self-tracking devices, apps or services and aggregate and manage that data, and the researchers who might use the data as part of their research.
Perspectives
Through a series of interviews and surveys, we discovered strong interest in contributing and using PHD for research. It should be noted that, because our goal was to access individuals and researchers who are already generating or using digital self-tracking data, there was some bias in our survey findings—participants tended to have more education and higher household incomes than the general population. Our survey also drew slightly more white and Asian participants and more female participants than in the general population.
Individuals were very willing to share their self-tracking data for research, in particular if they knew the data would advance knowledge in the fields related to PHD such as public health, health care, computer science and social and behavioral science. Most expressed an explicit desire to have their information shared anonymously and we discovered a wide range of thoughts and concerns regarding thoughts over privacy.

Equally, researchers were generally enthusiastic about the potential for using self-tracking data in their research. Researchers see value in these kinds of data and think these data can answer important research questions. Many consider it to be of equal quality and importance to data from existing high quality clinical or public health data sources.
Companies operating in this space noted that advancing research was a worthy goal but not their primary business concern. Many companies expressed interest in research conducted outside of their company that would validate the utility of their device or application but noted the critical importance of maintaining their customer relationships. A number were open to data sharing with academics but noted the slow pace and administrative burden of working with universities as a challenge.
In addition to this considerable enthusiasm, it seems a new PHD research ecosystem may well be emerging. Forty-six percent of the researchers who participated in the study have already used self-tracking data in their research, and 23 percent of the researchers have already collaborated with application, device, or social media companies.
The Personal Health Data Research Ecosystem
A great deal of experimentation with PHD is taking place. Some individuals are experimenting with personal data stores or sharing their data directly with researchers in a small set of clinical experiments. Some researchers have secured one-off access to unique data sets for analysis. A small number of companies, primarily those with more of a health research focus, are working with others to develop data commons to regularize data sharing with the public and researchers.
SmallStepsLab serves as an intermediary between Fitbit, a data rich company, and academic researchers via a “preferred status” API held by the company. Researchers pay SmallStepsLab for this access as well as other enhancements that they might want.
These promising early examples foreshadow a much larger set of activities with the potential to transform how research is conducted in medicine, public health and the social and behavioral sciences.

Opportunities and Obstacles
There is still work to be done to enhance the potential to generate knowledge out of personal health data:
•
Privacy and Data Ownership: Among individuals surveyed, the dominant condition (57%) for making their PHD available for research was an assurance of privacy for their data, and over 90% of respondents said that it was important that the data be anonymous. Further, while some didn’t care who owned the data they generate, a clear majority wanted to own or at least share ownership of the data with the company that collected it.
•
Informed Consent: Researchers are concerned about the privacy of PHD as well as respecting the rights of those who provide it. For most of our researchers, this came down to a straightforward question of whether there is informed consent. Our research found that current methods of informed consent are challenged by the ways PHD are being used and reused in research. A variety of new approaches to informed consent are being evaluated and this area is ripe for guidance to assure optimal outcomes for all stakeholders.
•
Data Sharing and Access: Among individuals, there is growing interest in, as well as willingness and opportunity to, share personal health data with others. People now share these data with others with similar medical conditions in online groups like PatientsLikeMe or Crohnology, with the intention to learn as much as possible about mutual health concerns. Looking across our data, we find that individuals’ willingness to share is dependent on what data is shared, how the data will be used, who will have access to the data and when, what regulations and legal protections are in place, and the level of compensation or benefit (both personal and public).
•
Data Quality: Researchers highlighted concerns about the validity of PHD and lack of standardization of devices. While some of this may be addressed as the consumer health device, apps and services market matures, reaching the optimal outcome for researchers might benefit from strategic engagement of important stakeholder groups.

We are reaching a tipping point. More and more people are tracking their health, and there is a growing number of tracking apps and devices on the market with many more in development. There is overwhelming enthusiasm from individuals and researchers to use this data to better understand health. To maximize personal data for the public good, we must develop creative solutions that allow individual rights to be respected while providing access to high-quality and relevant PHD for research, that balance open science with intellectual property, and that enable productive and mutually beneficial collaborations between the private sector and the academic research community.

complex adaptive systems, entrepreneurship, facts & data points, healthcare, healthy habits, policy, quantified self, rapid learning health systems, research methodology

Healthy Ageing Japan-style

 

http://www.abc.net.au/radionational/programs/saturdayextra/japan27s-aging-population/5397864

Japan’s ageing population

Saturday 26 April 2014 8:30AM
Japan's oldest communityIMAGE: RESIDENTS OF JAPAN’S OLDEST COMMUNITY (LATELINE)

A quarter of Japanese people are now aged over 65, with predictions that nearly half the population will reach that age by the end of the century.

In Japan people don’t just live longer, they work longer, stay healthier and approach old age in some interesting and innovative ways.

One policy initiative is old age day care which is well used and well organised in Japan.

Guests

Professor John Creighton Campbell
Visiting scholar, Institute of Gerontology at Tokyo University

Credits

Presenter
Dr Norman Swan
Producer
Kate Pearcy
data saving lives, health market quality, healthcare, healthy habits, policy, politics, rapid learning health systems, research methodology

NEJM: Mammography doesn’t pass muster…

Mammography = bad, according to the Swiss…

http://www.nejm.org/doi/full/10.1056/NEJMp1401875?query=TOC

Perspective

Abolishing Mammography Screening Programs? A View from the Swiss Medical Board

Nikola Biller-Andorno, M.D., Ph.D., and Peter Jüni, M.D.

April 16, 2014DOI: 10.1056/NEJMp1401875

Article

References
Comments (26)

In January 2013, the Swiss Medical Board, an independent health technology assessment initiative under the auspices of the Conference of Health Ministers of the Swiss Cantons, the Swiss Medical Association, and the Swiss Academy of Medical Sciences, was mandated to prepare a review of mammography screening. The two of us, a medical ethicist and a clinical epidemiologist, were members of the expert panel that appraised the evidence and its implications. The other members were a clinical pharmacologist, an oncologic surgeon, a nurse scientist, a lawyer, and a health economist. As we embarked on the project, we were aware of the controversies that have surrounded mammography screening for the past 10 to 15 years. When we reviewed the available evidence and contemplated its implications in detail, however, we became increasingly concerned.

First, we noticed that the ongoing debate was based on a series of reanalyses of the same, predominantly outdated trials. The first trial started more than 50 years ago in New York City and the last trial in 1991 in the United Kingdom.1 None of these trials were initiated in the era of modern breast-cancer treatment, which has dramatically improved the prognosis of women with breast cancer. Could the modest benefit of mammography screening in terms of breast-cancer mortality that was shown in trials initiated between 1963 and 1991 still be detected in a trial conducted today?

Second, we were struck by how nonobvious it was that the benefits of mammography screening outweighed the harms. The relative risk reduction of approximately 20% in breast-cancer mortality associated with mammography that is currently described by most expert panels2 came at the price of a considerable diagnostic cascade, with repeat mammography, subsequent biopsies, and overdiagnosis of breast cancers — cancers that would never have become clinically apparent. The recently published extended follow-up of the Canadian National Breast Screening Study is likely to provide reliable estimates of the extent of overdiagnosis. After 25 years of follow-up, it found that 106 of 484 screen-detected cancers (21.9%) were overdiagnosed.3 This means that 106 of the 44,925 healthy women in the screening group were diagnosed with and treated for breast cancer unnecessarily, which resulted in needless surgical interventions, radiotherapy, chemotherapy, or some combination of these therapies. In addition, a Cochrane review of 10 trials involving more than 600,000 women showed there was no evidence suggesting an effect of mammography screening on overall mortality.1 In the best case, the small reduction in breast-cancer deaths was attenuated by deaths from other causes. In the worst case, the reduction was canceled out by deaths caused by coexisting conditions or by the harms of screening and associated overtreatment. Did the available evidence, taken together, indicate that mammography screening indeed benefits women?

Third, we were disconcerted by the pronounced discrepancy between women’s perceptions of the benefits of mammography screening and the benefits to be expected in reality. The figureU.S. Women’s Perceptions of the Effects of Mammography Screening on Breast-Cancer Mortality as Compared with the Actual Effects. shows the numbers of 50-year-old women in the United States expected to be alive, to die from breast cancer, or to die from other causes if they are invited to undergo regular mammography every 2 years over a 10-year period, as compared with women who do not undergo mammography. The numbers in Panel A are derived from a survey about U.S. women’s perceptions,4 in which 717 of 1003 women (71.5%) said they believed that mammography reduced the risk of breast-cancer deaths by at least half, and 723 women (72.1%) thought that at least 80 deaths would be prevented per 1000 women who were invited for screening. The numbers in Panel B reflect the most likely scenarios according to available trials1-3: a relative risk reduction of 20% and prevention of 1 breast-cancer death. The data for Switzerland, reported in the same study, show similarly overly optimistic expectations. How can women make an informed decision if they overestimate the benefit of mammography so grossly?

The Swiss Medical Board’s report was made public on February 2, 2014 (www.medical-board.ch). It acknowledged that systematic mammography screening might prevent about one death attributed to breast cancer for every 1000 women screened, even though there was no evidence to suggest that overall mortality was affected. At the same time, it emphasized the harm — in particular, false positive test results and the risk of overdiagnosis. For every breast-cancer death prevented in U.S. women over a 10-year course of annual screening beginning at 50 years of age, 490 to 670 women are likely to have a false positive mammogram with repeat examination; 70 to 100, an unnecessary biopsy; and 3 to 14, an overdiagnosed breast cancer that would never have become clinically apparent.5 The board therefore recommended that no new systematic mammography screening programs be introduced and that a time limit be placed on existing programs. In addition, it stipulated that the quality of all forms of mammography screening should be evaluated and that clear and balanced information should be provided to women regarding the benefits and harms of screening.

The report caused an uproar and was emphatically rejected by a number of Swiss cancer experts and organizations, some of which called the conclusions “unethical.” One of the main arguments used against it was that it contradicted the global consensus of leading experts in the field — a criticism that made us appreciate our unprejudiced perspective resulting from our lack of exposure to past consensus-building efforts by specialists in breast-cancer screening. Another argument was that the report unsettled women, but we wonder how to avoid unsettling women, given the available evidence.

The Swiss Medical Board is nongovernmental, and its recommendations are not legally binding. Therefore, it is unclear whether the report will have any effect on the policies in our country. Although Switzerland is a small country, there are notable differences among regions, with the French- and Italian-speaking cantons being much more in favor of screening programs than the German-speaking cantons — a finding suggesting that cultural factors need to be taken into account. Eleven of the 26 Swiss cantons have systematic mammography screening programs for women 50 years of age or older; two of these programs were introduced only last year. One German-speaking canton, Uri, is reconsidering its decision to start a mammography screening program in light of the board’s recommendations. Participation in existing programs ranges from 30 to 60% — variation that can be partially explained by the coexistence of opportunistic screening offered by physicians in private practice. At least three quarters of all Swiss women 50 years of age or older have had a mammogram at least once in their life. Health insurers are required to cover mammography as part of systematic screening programs or within the framework of diagnostic workups of potential breast disease.

It is easy to promote mammography screening if the majority of women believe that it prevents or reduces the risk of getting breast cancer and saves many lives through early detection of aggressive tumors.4 We would be in favor of mammography screening if these beliefs were valid. Unfortunately, they are not, and we believe that women need to be told so. From an ethical perspective, a public health program that does not clearly produce more benefits than harms is hard to justify. Providing clear, unbiased information, promoting appropriate care, and preventing overdiagnosis and overtreatment would be a better choice.

The views expressed in this article are those of the authors and do not necessarily reflect those of all members of the expert panel of the Swiss Medical Board.

Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.

This article was published on April 16, 2014, at NEJM.org.

SOURCE INFORMATION

From the Institute of Biomedical Ethics, University of Zurich, Zurich (N.B.-A.), and the Institute of Social and Preventive Medicine and Clinical Trials Unit Bern, Department of Clinical Research, University of Bern, Bern (P.J.) — both in Switzerland; and the Division of Medical Ethics, Department of Global Health and Social Medicine, Harvard Medical School, Boston (N.B.-A.). Dr. Biller-Andorno is a member of the expert panel of the Swiss Medical Board; Dr. Jüni was a member of the panel until August 30, 2013.

data saving lives, facts & data points, healthy habits, musings, nutrition, policy, rapid learning health systems, storytelling

“Eat right. Get physical activity. Don’t smoke. Alcohol in moderation. Spend time with friends.”

http://www.vox.com/health-care/2014/4/22/5640636/dont-read-more-health-books-read-these-14-words

Don’t read more health books. Read these 14 words.

Updated by  on April 22, 2014, 3:30 p.m. ET 

You can do this. But you can also walk for 30 minutes a day.Donald Miralle/Getty Images for NASCAR

Thomas Frieden has a scary job. As director of the Centers for Disease Control and Prevention, he gets the call when infections begin defeating all known antibiotics, or Ebola resurfaces, or overdoses from prescription opiates begin skyrocketing.

Meanwhile, I’m the kind of person who won’t even go see movies about disease outbreaks. So when I sat down with Frieden recently, I asked him the question hypochondriacs need to know: What has all this data taught him to fear? What does he tell his family to do differently?

His answer was borderline dull:

Very little is different really. It’s basic. Wash your hands regularly. Get regular physical activity. Eat foods you love that are healthy. That’s one of the things that’s so challenging. Take physical activity as an example. You don’t have to have much, 30 minutes a day. Doing that, which can be three 10-minute walks, is going to make a huge difference in your life. You’ll feel better even if you don’t lose an ounce. You will be much less likely to have high blood pressure, high cholesterol, cancer, arthritis, depression. You’ll sleep better. And it doesn’t cost a cent.

There’s a lot a of things that can be done that are not very difficult and can make a really big difference. Of course, get your shots, get vaccination, get a flu shot every year and see the doctor regularly and if you have a problem make sure to get follow up.

The broader point — which came up again and again  in our interview — is that the main threats to health aren’t spectacular. People die from heart disease, car accidents, and tobacco a lot more often than they’re killed by Ebola, terrorism, and heroin.

The CDC Director’s reply reminded me of Michael Pollan’s famous, commonsense triplet about diet: “Eat food. Not too much. Mostly plants.” I asked whether Frieden had similarly concise advice. He did.

“Eat right. Get physical activity. Don’t smoke. Alcohol in moderation. Spend time with friends.”

Unlike a lot of health treatments, weird diets, and fancy exercise regimes you’ll read about, this advice is backed up by reams of rock-solid evidence — and following it costs next to nothing.

So there it is: in less than 15 words, the US official who probably knows better than anyone else what might kill you explains how to protect yourself.

Here’s my full interview with Frieden: