Posts tagged ‘research’

July 16, 2018

Here’s an Idea for an App

brainHere’s an idea for an app: Wouldn’t it be great if there were a smartphone app that could scan my tummy & tell me why it’s hurting? Is it a stomach virus, gluten exposure, FODMAP related, lactose intolerance, corn intolerance, salmonella, too much guar gum or carrageenan, natamycin, not enough fiber, too much fiber, the frequency of meals, or the fact that my sister is coming to visit? I’m willing to do whatever it takes to make it stop hurting. The problem is, it’s often difficult to determine what that is.

I was recently part of a team that reviewed a pilot research grant for a study of the effectiveness of an app vs traditional treatment. While we ultimately chose not to fund that particular grant, I see great possibilities in the future of apps to assist healthcare professionals with diagnosis and treatment of disease and chronic conditions, the physical manifestations of trauma, and mental health issues in general.

While the human element offers insight that may be missed by technology, it also brings inherent bias and inconsistency. In the 1960s, the Oregon Research Institute set out to study how experts rendered judgments. Lew Goldberg, a psychologist, developed a case study in which researchers gathered a group of radiologists and asked them how they determined from a stomach X-ray whether a patient had cancer.

The doctors indicated that there were seven major cues that they looked for. In an effort to create an algorithm that would mimic the decision making of doctors, the researchers created a simple algorithm in which the likelihood of malignancy depended on the seven cues the doctors had mentioned, all equally weighted.

Researchers then presented the doctors with X-rays from 96 different individual stomach ulcers and asked them to rate each one on a seven-point scale from definitely malignant to definitely benign. Without disclosing what they were doing, the researchers showed the doctors each ulcer twice with the duplicates mixed in randomly so that the radiologists wouldn’t notice the duplication.

All data were transferred to punch cards and sent to UCLA for computer analysis. When UCLA sent back the analyzed data, it became clear that this simple computer model was surprisingly good at predicting the doctors’ diagnoses. Even more surprising, the data showed that the diagnoses were all over the place. In spite of the fact that they were trained experts, the radiologists didn’t agree with each other. In fact, they often didn’t agree with themselves. Every single doctor had sometimes contradicted his own diagnosis when given a duplicate X-ray.

The researchers also found that clinical psychologists and psychiatrists deciding whether it was safe to release a patient from a psychiatric hospital wildly differed from each other in their determinations. Further, those with the least training were just as accurate in their judgments as those with more training.

The Oregon researchers then tested the hypothesis that the simple computer model they had designed might be better than doctors at diagnosing cancer. Turns out, the algorithm outperformed even the single best doctor in the group of doctors being studied.

What Goldberg came to realize was that doctors had a good theory of the cues to look for in diagnosing cancer, but in practice they did not stick to their own ideas of how to best diagnose. They tended to weigh things differently. As a result, they were less accurate than a computer model.

Given our current reliance on experts to diagnose, this research isn’t particularly reassuring; however, it does bode well for the inclusion of artificial intelligence in diagnostic procedures. That’s right, just the sort of technology that could be deployed by an app on my handheld device.
floating apps
Here’s an idea for an app

A decade ago, I attended the Game Developers Conference in Austin, Texas. There were sessions on massively multiplayer online (MMO) games, animation for video games, avatar development, and artificial intelligence in video games. I remember thinking as I sat through one of the sessions – the highest and best use of characters in a game who can learn from conflict would be to develop “games” or tools for families to learn to resolve conflict and improve communication.

If I create an avatar that behaves like me at first, but learns better ways to navigate specific situations, I can learn to improve my game, i.e., my life. With the distance of “playing” myself, I gain perspective. I still think there’s great potential for emotional and social growth applications.

Here’s an idea for an app

A couple of months ago, I spoke to the Trauma Institute & Child Trauma Institute in Northampton, MA about a new progressive counting method used to treat PTSD and the effects of childhood trauma. Essentially, the patient verbalizes their first chronological memory of trauma while the therapist counts. This process continues until the distress associated with that memory is resolved. Then the patient moves on to the next distressing memory and repeats the process.

I’m sure it’s a little more complicated than that, but my first thought was – I wonder if you can make a phone count out loud? If so, it seems like a lot of this could be done with a smartphone. Maybe you’d do a couple of sessions with a practitioner at the beginning and periodically thereafter, but the rest could be done in the safety and comfort of your own home. We need an app for that.

Well researched and well designed apps have the potential to propel us forward. Whether or not they include my ideas, I’m excited about their incorporation into medical and mental health practices.

http://www.ori.org/scientists/lewis_goldberg

http://www.ori.org/

http://psycnet.apa.org/record/1970-12828-001

http://michaellewiswrites.com/#top

http://www.childtrauma.com/

http://www.gdconf.com/

http://www.cooking2thrive.com/blog/make-it-easier-to-stick-to-your-eating-plan/

July 3, 2018

Your Gut Has a Mind of Its Own

If you feel like your gut has a mind of its own, it’s because it does. The billions of neurotransmitters in your intestine are of the same type as those in your brain and house the Enteric Nervous System. The gut is capable of a level of independent intelligence equal to that of your dog.
diet
Does that mean our stomachs can be trained?

It’s kind of a funny idea, but it’s one that’s currently being explored. Some scientists hypothesize that we can treat stomach pain using hypnosis — essentially curing our tummies by talking to them.

The gut is host to 100,000 billion bacteria. When researchers mapped the DNA of one study participants’ microbiomes, they first reported that each of us falls into one of 3 enterotypes.

Subsequent research has called this limited number and the specific characteristics within each type into question. Things may be a bit more nuanced and complicated than originally indicated. Research continues and will bring a clearer picture over time.

We do know that the gut communicates with the brain via the vegas nerve and can affect our emotions. That could be why it feels like the gut has a mind of its own that sometimes controls us.

Ninety-five percent of the seratonin in our bodies is produced in the gut where it regulates the immune system and sets the pace for intestinal transit. Seratonin is also released into the bloodstream acting on the hypothalamus and registering in the upper brain as a sense of well-being.

With conditions like irritable bowel syndrome (IBS) in which there is no observable organic malfunction, it is theorized that there could be a problem between brain and gut communication. One of the brains may send the wrong message or a message may be misinterpreted resulting in the symptoms experienced.

Learning more about this possible process may lead to innovative treatments for the 1 in 10 of us who suffer from IBS. It also has potential benefit for those who have become hypervigilant as a result of trauma.

An examination of the microbiome can increasingly assist in diagnosis and treatment of disease. The microbiome can show a propensity for Type II diabetes, heart disease, and liver disease and may influence obesity. Patients with inflammatory bowel disease (IBD) show an increase in pro-inflammatory molecules and a decrease in inflammatory dampening bacteria. Altering microbial composition could possibly be used to reduce inflammation or calm down the immune system.

Researchers have successfully diagnosed Parkinson’s disease through intestinal biopsy paving the way for additional exploration of the possibility that the gut and brain share diseases. This could be key to a greater understanding of autism spectrum disorders and alzheimer’s disease.

Dr. Michael Gershon, Professor of Pathology and Cell Biology at Columbia University Irving Medical Center who is sometimes referred to as the father of neurogastroenterology has, along with Dr. Anne Gershon, demonstrated that shingles can occur in enteric neurons and may be the cause of several gastrointestinal disorders currently of unknown origin.

It’s a little unclear whether the DNA of a microbiome is a set entity that changes slowly over time or whether researchers were simply mapping a DNA moment in a constantly changing microbiota. Studies have shown that the microbiota can change within one day with a change in diet.

That sounds like great news to me! It’s possible that a change in diet could bring symptom relief fairly quickly once we better understand what in the diet needs to be altered.

The possibilities are huge and the research has just begun. Changing the microbiome through diet, prebiotics, and probiotics may have a much greater effect in preventing and reducing disease than we previously believed. Diet may not just be fuel to keep the body strong, it may be real medicine that can be used to reduce inflammation, revise autoimmune response, and change the messages transmitted from the gut to the brain.

Knowing that my gut has a mind of its own sounds like relief to my upper brain!

https://www.pathology.columbia.edu/profile/michael-d-gershon-md

http://sales.arte.tv/fiche/3707/VENTRE__NOTRE_DEUXIEME_CERVEAU__LE_

http://stm.sciencemag.org/content/1/6/6ra14.short

https://www.mdedge.com/jfponline/article/105514/gastroenterology/targeting-gut-flora-treat-and-prevent-disease

https://www.ncbi.nlm.nih.gov/pubmed/25786900

https://www.pathology.columbia.edu/profile/michael-d-gershon-md

April 18, 2017

The Best Supplement May Be A Grain of Salt

When it comes to your health, the best supplement may be a grain of salt. I’m currently participating in a pilot program at the local medical school in which patients meet with researchers to learn about the research process and how we can participate beyond being research subjects. The program is fascinating. It gives us a glimpse into current trends in medical thought, and it makes us highly aware of the limits that plague medical research, the most frequent being time and money.
salt
Limited time and/or money usually lead(s) to smaller studies. Smaller studies are less representative of the population as a whole and thereby less definitive. Studies get published in medical journals, and along the way some ideas take hold in the medical community. Sometimes these ideas are incorporated into standard medical care even when there’s little evidence to support their clinical relevance.

A recent example of this is the practice of testing vitamin D levels when patients report malaise, fatigue or other nonspecific complaints. According to the CDC, the number of blood tests for vitamin D among Medicare recipients increased 83-fold from 2000-2010 and 2.5-fold from 2009-2014 for those with commercial insurance. At the same time, labs performing these tests started reporting normal levels of 20 to 30 nanograms vitamin D per milliliter of blood as insufficient.(1) As a result, many healthy people began to believe they had a deficiency.
fish oil
When numerous studies over the past decade linked low levels of vitamin D to cancer, heart disease, and diabetes, the millions who believed themselves to be deficient began, or were advised, to consume vitamin D supplements. I am one of those who received such advice after routine blood work. The problem is that the existing studies do not provide widely accepted evidence that vitamin D is helpful in preventing or treating these diseases. In fact, current evidence suggests that the main beneficial effects of vitamin D supplements relate to conditions of the muscles, bones, and joints.

And the vitamin D deficiency movement isn’t the first physician advanced idea based on insufficient evidence. Last year, newly issued dietary guidelines removed the restriction on cholesterol consumption because “it is now acknowledged that the original studies purporting to show a linear relation between cholesterol intake and coronary heart disease (CHD) may have contained fundamental study design flaws, including conflated cholesterol and saturated fat consumption rates and inaccurately assessed actual dietary intake of fats by study subjects.”(2)

And the possibly well-intentioned, oft repeated advice to add multivitamins to your regimen because they will make you healthier turns out to be false as well. A growing body of evidence suggests that multivitamins offer little to no health benefits. A study published in the December 17, 2013 issue of the journal Annals of Internal Medicine found that multivitamin and mineral supplements did not work any better than placebo pills.
test tube
We tend to regard science as infallible or research as indisputable. It’s not. We only know as much as we know in this moment. Our knowledge base will always be growing. Today’s theories will sometimes be proven wrong. Some studies will be statistically significant, but clinically irrelevant. Many studies will have too narrow a focus, too small a sample, or too short a term for the results to be taken as definitive on their own.

As patients, we are vulnerable to misinformation bombarding us from corporations that create supplements, food, and medications. Unfortunately, we are also vulnerable to imperfect science and bias within the medical community. To some degree this is unavoidable. This is where a grain of salt can come in handy. Skepticism can lead you to seek additional information.

If you are not medically trained, you cannot assume you know more than your doctor. You can, however, recognize that you have the final word regarding your healthcare. You have every right to ask questions with the expectation of a well-supported, forthright answer. You have the right to your health records. You have the right to seek a second opinion or a third. A second doctor may interpret your test results in a different manner than the first.

And barring an emergency situation, I’ll posit that you have a responsibility to yourself to remain skeptical regarding treatment recommendations until you become well-informed. That being said, the best supplement available for healthcare may be a grain of salt.

Disclosure of Material Connection: I have not received any compensation for writing this post. I have no material connection to the brands, products, or services that I have mentioned. I am disclosing this in accordance with the Federal Trade Commission’s 16 CFR, Part 255: “Guides Concerning the Use of Endorsements and Testimonials in Advertising.”

1)https://www.nytimes.com/2017/04/10/health/vitamin-d-deficiency-supplements.html?_r=0
2)https://www.ncbi.nlm.nih.gov/pubmed/19751443
https://people.hss.caltech.edu/~camerer/Ec101/JudgementUncertainty.pdf
http://www.medlabme.com/magazine-issues/2016/diagnostics/vitamin-d-assays/
https://www.hsph.harvard.edu/nutritionsource/2016/01/07/new-dietary-guidelines-remove-restriction-on-total-fat-and-set-limit-for-added-sugars-but-censor-conclusions/
http://annals.org/aim/article/1767855/vitamin-mineral-supplements-primary-prevention-cardiovascular-disease-cancer-updated-systematic