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For this, they established a number of prognostic indices to predict the life expectancy in older and terminally ill patients. The main purpose of this project is to provide doctors, care givers as well as patients and their family members with information that can help prevent overtesting and overtreatment.

An Online Service Lets Doctors Calculate Mortality Risks

The UCSF team has also posted an interactive website online, called “ePrognosis.org,” which can be used to calculate a person’s mortality risk based on specific data, including age, health conditions, cognitive status, functional ability, etc.

“This is the first time such tools have been assembled for physicians in a single online location,” wrote Paula Span of the New York Times who reported on the project (1/11/2012) after a review was published in The Journal of the American Medical Association last week.

Among experts, responses have so far been mostly positive. “This kind of synthesis is very helpful for [health care] providers, researchers and some patients,” said Dr. Susan L. Mitchell, a geriatrician at Harvard University and researcher at Hebrew SeniorLife in Boston who was quoted in the Times article.

“A more frank discussion of prognosis in the elderly is sorely needed,” said Dr. Sei Lee, a geriatrician at UCSF and one of the authors of the review. A more accurate assessment of a patient’s life expectancy could help doctors and families evaluate, for example, whether an older person with a terminal disease should continue receiving treatments that may cause more pain and discomfort than relief, according to Dr. Lee. It may also be useful in determining how vigilant a patient has to be in observing and maintaining certain treatment- and lifestyle measures.

Since no calculation of life expectancy – other than based on data collected by U.S. Census Bureau – has so far existed, there is now hope that relatively easily accessible assessment tools like ePrognosis will be able to better assist health care providers with their decision making process.

In fact, many clinical decisions for older and terminally ill patients include considerations of life expectancy. But “at present, physicians are often shooting in the dark when they recommend tests, treatments and medications for older patients. […] Even when interventions do work, the benefits can be years away. Doctors have no easy way to know whether their elderly patients will live long enough to experience them. The potential for complications and side effects, however, is immediate,” wrote Ms. Span.

While it is true that with declining life expectancy some treatments may do more harm than good, it is not altogether clear whether accurate predictions can ever be made for an individual patient, cautioned Dr. Kenneth Covinsky, professor at the Department of Medicine, Division of Geriatrics at UCSF. “The accuracy of prognostic indices is often tested under ideal and controlled conditions,” he said. “When you see a research report of a prognostic index, you see how well it did in a group of patients specified by the researchers. But how accurate will the index be in your patient? […] Your patients are never quite the same as the patients in the research study.”

As a prognostic aid, programs like ePrognosis may turn out to be quite valuable, “if used to supplement clinical judgment,” said Dr. Covinsky. “Clinicians (and patients too) now have easy access to these prognostic indices. […] But perhaps the danger of ePrognosis is that it is too easy. In a matter of minutes, you can input a few elements of patient data and the calculator will spit out a probability of survival,” he added.

Some critics have pointed out that the very idea of basing decisions in medical care on calculations such as these may be a slippery slope. They say that assessing a patient’s life expectancy should never be the starting point of any form of treatment. Dr. Lee freely admitted there are potential problems. Because it is not clear whether calculating prognostic indices will ultimately improve patient care in clinical settings, he said, the researchers stopped short of urging widespread use at this time, according to the Times.

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Ms. Deen, who is widely known for her unapologetic preferences for heavy cooking styles, says she knew of her medical condition for about three years but decided to keep it private. Critics have been quick to question her motives, suspecting she didn’t come forward out of fear of losing her lucrative show on the Food Network, which has millions of followers.

A Celebrity Chef Refuses to Learn from Her Mistakes

Despite of her diagnosis, Ms. Deen, 64, doesn’t blame herself for causing her illness through unhealthy eating habits. In an interview with The New York Times (1/18/2012), she said she did not plan on changing her lifestyle or cooking but will consider reducing portion sizes of the unhealthful foods. “I’ve always preached moderation,” she said.

Others disagree with that assertion. In a widely publicized interview with TV Guide, one of her fellow-celebrity chefs, Anthony Bourdain, called her “the worst, most dangerous person” on the Food Network. “There is no denying that Paula’s food has a lot of what we call the deadly triangle: fat, sugar and salt,” said Geralyn Spollett, Director of Education at the American Diabetes Association in an interview with the Times.

Ms. Deen has long defended herself against such criticism. “I cook for regular families who worry about feeding their kids and paying the bills, she said in an interview with The New York Post. Her supporters concur. “She feels like she cooks for ‘real people,’ and for better or worse, that is how many people in this country choose to eat,” writes Virginia Willis, a food writer in Atlanta, Georgia.

All of this may be true. Still, it is one thing to acknowledge people’s budget limits, but it is another matter entirely to promote cooking styles and eating habits that are known to be outright unhealthy.

Health problems such as obesity, diabetes, high blood pressure and heart disease are most widespread among those with low incomes and less education. These are the men, women and children who would greatly benefit from being offered better alternatives to their existing diet choices. Instead, Ms. Deen promotes a message that willfully disregards the warnings of health experts and in fact sabotages efforts to reverse the worst public health crisis in our history. As such, she is part of the problem.

Even more disturbing is Ms. Deen’s newest endeavor. As reported in the Times, she has now accepted the role of a paid spokesperson for Novo Nordisk, a Danish pharmaceutical company and the maker of a drug named “Victoza,” a diabetes medication. In this position, she will spearhead an advertising campaign titled “Diabetes in a New Light.” It is quite ironic to see someone who has long decried her critics as “elitists” advertise a drug that costs about $500 a month.

One might argue that Ms. Deen knows how to make lemonade out of lemons. But before you say, “good for her,” let’s think for a moment about the implication of the message she’s giving out now: Don’t let anyone tell you what to eat and how to live your life – and if it makes you sick, well, there is always Victoza (if you can afford it). It would be more commendable if she were honest with her fans and use her clout to promote healthier diet- and lifestyle choices that make these kinds of drugs less necessary in the first place.

For Ms. Deen herself this could be a teachable moment. Why not open the next show with a line like this: “My dear viewers – for years I have promoted cooking techniques and eating styles I thought were tasty and affordable. Now I know that eating this way has made me seriously ill. I’ve learned from my mistakes. That is why, from hereon in, I want to invite you to join me in my new efforts to cook lighter and eat healthier, so that you don’t have to suffer the same consequences.”

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The survey found that young adults and especially young women were susceptible to mental illness to a degree that it substantially interfered with their lives. SAMHSA defines mental illness as “diagnosable mental, behavioral or emotional disorders.”

Especially the Young Are Increasingly Affected
By Substance Abuse and Mental Illness

For the study, SAMHSA surveyed over 67,500 participants aged 12 and older in all parts of the United States. The results showed that almost 2 million teenagers experienced at least one bout of depression, which is defined as a period lasting at least two weeks. Nearly 9 million adult Americans had serious thoughts of suicide, with 2.5 million making suicide plans and 1.1 million making an actual attempt.

The study results came as a surprise, according to Peter Delany, Director of SAMHSA’s Office of Applied Studies. “We all know people who have had a depression or anxiety disorder,” he said, “but this is a pretty big number.” He said he was somewhat reluctant to speculate on the reasons for these developments, which are not easy to pinpoint. “The recent economic downturn may be a factor for some, but these conditions are multifactorial – there are biological issues, there are social issues and also personal issues.”

Delany thinks that many people who are struggling don’t seek treatment because of the stigma that is often attached to mental illness. Many also lack insurance coverage to pay for their care. According to SAMHSA, less than 40 percent of those with a mental illness receive health services. That’s extremely unfortunate, said Delany. “We know with the appropriate use of medication and with good treatment people can recover and go on to lead very healthy and productive lives,” he said.

Other experts agree. “Mental illness is a treatable problem,” according to Dr. Ihsan Salloum, Director of the Addiction Psychiatry and Psychiatric Comorbidity Programs at the University of Miami School of Medicine. “[But] there is a gap between the need and how many people reach treatment,” he added.

SAMHSA also investigated connections between mental illness and substance abuse such as use of cocaine, hallucinogens, inhalants and heroin. In its report, the agency concluded that people who abused drugs or alcohol showed substantially higher rates of mental illness than those who did not – 20 percent versus 6 percent. Teenagers who suffered from extended periods of depression were twice as likely to develop drug problems than their peers who did not have such experiences.

As alarming as the SAMHSA report sounds, it is also somewhat vague because it compiles a number of different issues that may be connected but are by no means identical. For instance, thoughts of suicide may not always be symptoms of mental illness but can result from deep despair. Hopelessness is not necessarily a mental dysfunction but can be a conceivable reaction in the face of extraordinarily dire situations. Alcohol and drug abuse are far too widespread among the general population to label them as symptoms of actual mental illness. People use them for recreational purposes and often, of course, to numb themselves in times of heightened stress and anxiety.

Still, the report should give us pause and have us ask how dysfunctional our lives must have become to cause so much suffering especially among the young who are supposed to look to the future with optimism and confidence. Hardly a promising picture for all of us.

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What’s on the food politics agenda for 2012? Can we expect anything good to happen? By “good,” I mean actions that make our food system safer and healthier for consumers, farmers, farm workers and the planet. Ordinarily, I am optimistic about such things. This year? Not so much. The crystal ball is cloudy.

Political leaders will avoid or postpone taking action on food issues that threaten corporate interests. Sometimes Congress acts in favor of public health, but 2012 is an election year. Expect calls for corporate freedom to take precedence over those for responsible regulations. Maybe next year?

Some Improvements We Can Expect
And Some We Can Only Hope for

Something will happen on the farm bill, but what? Last fall’s secret draft bill included at least some support for producing and marketing fruits and vegetables, and only minimal cuts to SNAP (food stamps). Once that process failed, Congress must now adopt that draft, start over from scratch or postpone the whole mess until after the election.

SNAP participation will increase, but so will pressure to cut benefits. With the economy depressed, wages low and unemployment high, demands on SNAP keep rising. In 2011, SNAP benefits cost $72 billion, by far the largest farm bill expenditure and a tempting target for budget cutters. While some advocates will be struggling to keep the program’s benefits intact, others will try to transform SNAP so it promotes purchases of more healthful foods. Both groups should expect strong opposition.

Childhood obesity will be the flash point for fights about limits on food marketing. The Lancet recently summarized the state of the science on successful obesity interventions: Taxes on unhealthy foods and beverages, restrictions on marketing such items, traffic-light front-of-package food labels, and programs to discourage consumption of sugar-sweetened drinks and television viewing. Expect the food industry to continue to get Congress to block such measures, as it did with U.S. Department of Agriculture (USDA) school nutrition standards (hence: pizza counts as a vegetable).

The Federal Trade Commission (FTC) will postpone release of nutrition standards for marketing to children. Although Congress asked for such standards in the first place – and the standards are entirely voluntary – it just inserted a section in the appropriations bill requiring a cost-benefit analysis before the FTC can release them. Why does the food industry care about voluntary restrictions? Because they might work (see previous prediction).

The Food and Drug Administration (FDA) will delay issuing front-of-package labeling guidelines as long as it can. The FDA asked the Institute of Medicine (IOM) for advice about such labels. The institute recommended labels listing only calories, saturated and trans fat, sodium and sugars – all nutrients to avoid. Although the institute did not mention traffic-light labels, it did recommend check marks or stars, which come close. The food industry much prefers its own method, “Facts Up Front,” which emphasizes “good-for-you” nutrients. It is already using this system. Will the FDA try to turn the institute recommendations into regulations? Maybe later.

The FDA will (still) be playing catch-up on food safety. The FDA got through the 2011 appropriations process with an increase of about $50 million for its inspection needs. This is better than nothing but nowhere near what it needs to carry out its food safety mandates. The FDA currently inspects less than 2 percent of imported food shipments and 5 percent of domestic production facilities. The overwhelming nature of the task requires the FDA to set priorities. Small producers think these priorities are misplaced. Is the FDA going after them because they are easier targets than industrial producers whose products have been responsible for some of the more deadly outbreaks? Time will tell.

On the bright side, the food movement will gather even more momentum. While the food industry digs in to fight public health regulations, the food movement will continue to attract support from those willing to promote a healthier and more sustainable food system. Watch for more young people going into farming and more farmers’ markets, farm-to-school programs, school meal initiatives, and grassroots community efforts to implement food programs and legislate local reforms.

There is plenty of hope for the future in local efforts to improve school meals, reduce childhood obesity, and make healthier food more available and affordable for all.

This article was first published in the San Francisco Chronicle.

Marion Nestle, PhD, MPH is the author of many influential books, among them “Food Politics,” “Safe Food,” “What to Eat” and “Pet Food Politics.” She teaches as Professor in the Nutrition, Food Studies and Public Health Department at New York University. For more information, visit her blog www.foodpolitics.com

The articles written by guest contributors are the sole responsibility of the individual writers in terms of factual accuracy and opinion and do not necessarily reflect the views of the publisher of this blog.

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For the study, researchers tested 7,000 men and women over a period of 10 years for memory, vocabulary and aural and visual comprehension. The results showed an average of 3.6 percent decline in reasoning skills in both sexes at the age of 45 to 49. 65 to 70 years old men showed on average a steeper decline than women of the same age group – 9.6 versus 7.4 percent.

Cognitive Decline May Begin Much Earlier in Life

Since the youngest participants were 45 years old when the study began, it is possible that the deterioration of brain functions may commence even earlier, according to Dr. Archana Singh-Manoux, the leader of the research, which was co-sponsored by the Center for Research in Epidemiology and Population in France and the University College London. The results were recently published in the “British Medical Journal.”

Previous studies on age-related decline of mental health have primarily focused on people in their sixties, seventies and beyond. By limiting ourselves to a narrower scope, we may not yet have gotten the entire picture, according to Dr. Singh-Manoux. A decline of mental capacity doesn’t suddenly happen at old age. That variability exists much earlier on, she says.

Researchers still need to learn more about the risk factors that lead to progressive cognitive impairment. There is strong evidence that Alzheimer’s disease and other forms of dementia is closely related to heart disease, which is typically caused by weight problems, high blood pressure and high cholesterol.

We probably underestimate how affected the broader population may be, says Dr. Singh-Manoux. The participants in this study were drawn from a relative homogeneous pool of office workers who were well educated and, for the most part, enjoyed a comfortable life and good health. This is not necessarily a representative profile at a time when so many suffer from obesity and other lifestyle-related health issues.

Although the causes of mental decline are not yet fully understood, experts recommend a number of measures that may not prevent but at least slow down the process. These include regular physical exercise, healthy nutrition, weight control, intellectual activity, avoidance of smoking and alcohol/drug abuse, stress reduction, sufficient amounts of sleep as well as social activities and supportive relationships.

A study conducted by the Mayo Clinic concluded that engaging in stimulating mental activities through reading, discussion, playing challenging games and other interactions can help decrease the risk of cognitive impairment significantly. This does not only apply to the elderly. To prevent even mild cognitive impairment (MCI), it is important to “exercise” the brain at any age.

“This study… demonstrates that aging does not need to be a passive process,” says Dr. Yonas Geda, a Mayo Clinic neuropsychiatrist and lead author of the study report. “By simply engaging in cognitive exercise, you can protect against future memory loss.”

To what degree we actually hold the key to our mental health remains to be seen. Preserving our physical health as best as we can is certainly a good strategy. Baby boomers have long been spending millions to save their sagging skin, fix their crow’s feet and plump their lips. As they reach old age, they finally are beginning to turn to brain boosters to fight memory loss, writes Virginia Anderson of WebMD in an article titled “Seven Brain Boosters to Prevent Memory Loss.” In fact, the process may begin much earlier in life and people need to pay attention before it’s too late.

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