Is technology addiction messing with your brain?

my brains - let me show you them
Image by Liz Henry via Flickr

This is your life? Beginning at breakfast — or perhaps earlier, in the bathroom — one sizable screen with multiple streams of news, stock reports and data updates across the bottom; tweets in a box on the left; the iPhone nearby holding stacked up e-mails, IMs and calls that went into the mailbox? If so, you are not alone. As a matter of fact, it seems almost no one is alone, or disconnected from technological communications, any more. In the words of New York Times writer Matt Richtel, “This is your brain on computers.”

Scientists say juggling e-mail, phone calls and other incoming information can change how people think and behave. They say our ability to focus is being undermined by bursts of information.

These play to a primitive impulse to respond to immediate opportunities and threats. The stimulation provokes excitement — a dopamine squirt — that researchers say can be addictive. In its absence, people feel bored.

The resulting distractions can have deadly consequences, as when cellphone-wielding drivers and train engineers cause wrecks. And for millions of people … these urges can inflict nicks and cuts on creativity and deep thought, interrupting work and family life.

While many people say multitasking makes them more productive, research shows otherwise. Heavy multitaskers actually have more trouble focusing and shutting out irrelevant information, scientists say, and they experience more stress.

Richtel follows a family of four through their technology-addicted lives: they go on an oceanside vacation, but soon are all on their electronic devices; one day at the beach is mercifully unplugged. But on routine days, few moments are unplugged.

“And scientists are discovering,” Richtel reports, that even after the multitasking ends, fractured thinking and lack of focus persist. In other words, this is also your brain off computers.”

“The technology is rewiring our brains,” said Nora Volkow, director of the National Institute of Drug Abuse and one of the world’s leading brain scientists. She and other researchers compare the lure of digital stimulation less to that of drugs and alcohol than to food and sex, which are essential but counterproductive in excess.

Technology use can benefit the brain in some ways, researchers say. Imaging studies show the brains of Internet users become more efficient at finding information. And players of some video games develop better visual acuity.

More broadly, cellphones and computers have transformed life. They let people escape their cubicles and work anywhere. They shrink distances and handle countless mundane tasks, freeing up time for more exciting pursuits.

For better or worse, the consumption of media, as varied as e-mail and TV, has exploded. In 2008, people consumed three times as much information each day as they did in 1960. And they are constantly shifting their attention. Computer users at work change windows or check e-mail or other programs nearly 37 times an hour, new research shows.

The nonstop interactivity is one of the most significant shifts ever in the human environment, said Adam Gazzaley, a neuroscientist at the University of California, San Francisco.

“We are exposing our brains to an environment and asking them to do things we weren’t necessarily evolved to do,” he said. “We know already there are consequences.”

We just don’t fully understand what those consequences might be. This space worries. Couldn’t we get our adrenaline the old-fashioned way?

Your Brain on Computers – Attached to Technology and Paying a Price – NYTimes.com.

Breaking news on broken-down joints

There’s old news — joint replacements for athletes are downright commonplace, seniors in their 80s and 90s are getting new hips — and now there’s good news. Researchers at the University of California San Francisco, led by sports medicine chief C. Benjamin Ma MD, are finding that damage to the cartilage connecting the foot bone to the ankle bone to the leg bone etc might not have to be permanent.

As almost anyone with a series of sports injuries may know, cartilage damage is permanent. In the words of Dr. Benjamin Ma, chief of sports medicine at UCSF, “cartilage is just lazy” — it doesn’t like to regenerate, so when it gets damaged or worn down through use or injury, it won’t come back on its own.

But Ma and his research team have discovered that given very specific circumstances, cartilage will, in fact, regenerate. The team has been taking knee cartilage from subjects and placing it on a matrix and under some very specific conditions, it is forced to regenerate.

“Cartilage cells are very lazy. They don’t like to grow if they don’t have to,” he said. “So we fool them by doing this particular maneuver and they feel they have to grow, and they form new cartilage. Then we glue it back into the knee.”

The new method has proved to be safe and it helps improve function, and now it is undergoing Phase 3 clinical trials to see whether it in fact works better than microfracture surgeries currently used to treat cartilage injuries.

Down the road, Ma and his team hope to see if there is an application of this method that could help people suffering from arthritis, which is also a cartilage disorder.

That cheer being heard across cyberspace is coming from millions of amateur athletes and the entire population over 50, almost every one of whom could use a little newly invigorated cartilage.

Read more at the San Francisco Examiner.

'Lesbian Health 101' seeks to open doors, minds

Years ago a lesbian friend, who would soon die of uterine cancer, told me how she hated going to her gynecologist and consistently postponed it. “I’m sitting there in the middle of all those bulging bellies and beatific smiles,” she said, “like some sort of an alien.”

How I wish she were alive, so I could send this clipping from the San Francisco Chronicle:

When Dr. Patricia Robertson held the first lesbian health clinic at San Francisco General Hospital in 1978, she decided to cover the “family planning” signs in the lobby – she didn’t want to deter patients who thought gynecologists were only for dispensing birth control and helping women get pregnant.

“We wanted to put together evidence-based research that would support clinical guidelines, so when we talk about why lesbians are different from heterosexual women we can back that up,” said Robertson, who is a professor in the UCSF department of obstetrics, gynecology and reproductive sciences. “Doctors are going to be able to legitimize their advice after they read this book.”

The article points out that although progress has been made in health care since then, “lesbians are more likely than straight women to suffer depression and drug and alcohol abuse. They may be less likely to get regular health screenings like pap smears and breast exams.

With those disparities in mind, Robertson and Suzanne Dibble, a registered nurse with the Institute for Health and Aging in the UCSF School of Nursing, have put together the first textbook on lesbian health care. ‘Lesbian Health 101’ was released this month.

The textbook is written in medical language and designed for doctors, nurses and other health care providers, although Robertson and Dibble say they’re encouraging lesbians to use it as a resource for understanding their own health issues. Most of the chapters were written by health care providers who are also lesbian.

Chapters in the nearly 600-page book focus on a wide variety of health issues, from heart disease and breast cancer to partner violence and how to decide which woman in a relationship should get pregnant.Some sections focus on the risk factors that affect lesbians more than straight women – higher smoking rates, for example, or what effect not having children might have on breast cancer risks – while others address how doctors can best meet the particular needs of lesbian patients.

Many of the health issues that affect lesbians can be tied to stress related to their sexual orientation, Dibble said. Discrimination, the stress of coming out to family and friends, or feeling ostracized and alone can all lead to health problems.

Dr. Erica Breneman, an obstetrician-gynecologist with Kaiser Permanente in Oakland, said she’s pleased to see such a textbook available to doctors now, even if it’s troubling that the book is even necessary.

“In a perfect world, we wouldn’t need this,” Breneman said. “A woman who happens to be gay shouldn’t need much that’s terribly different than a woman who is straight. But the reality is, because of the particular demographics of lesbian women, they do have other health issues.”

Perfect worlds, it seems, are slow in coming.

‘Lesbian Health 101’ seeks to open doors, minds.

Walking while cellphoning can be hazardous to your health

Having raged and ranted about phoning/texting drivers and pedestrian-oblivious bikers, this space would now like to come to the defense of cellphoning walkers. Not, you understand, multi-tasking/app-studying cellphoning walkers, but talking walkers. Noting the attention that has recently focused on the hazards of distracted drivers, New York Times writer Matt Richtel reports on the new hazard:

But there is another growing problem caused by lower-stakes multitasking — distracted walking — which combines a pedestrian, an electronic device and an unseen crack in the sidewalk, the pole of a stop sign, a toy left on the living room floor or a parked (or sometimes moving) car.

The era of the mobile gadget is making mobility that much more perilous, particularly on crowded streets and in downtown areas where multiple multitaskers veer and swerve and walk to the beat of their own devices.

Most times, the mishaps for a distracted walker are minor, like the lightly dinged head and broken fingernail, a jammed digit or a sprained ankle, and, the befallen say, a nasty case of hurt pride. Of course, the injuries can sometimes be serious — and they are on the rise.

Slightly more than 1,000 pedestrians visited emergency rooms in 2008 because they got distracted and tripped, fell or ran into something while using a cellphone to talk or text. That was twice the number from 2007, which had nearly doubled from 2006, according to a study conducted by Ohio State University, which says it is the first to estimate such accidents.

“It’s the tip of the iceberg,” said Jack L. Nasar, a professor of city and regional planning at Ohio State, noting that the number of mishaps is probably much higher considering that most of the injuries are not severe enough to require a hospital visit. What is more, he said, texting is rising sharply and devices like the iPhone have thousands of new, engaging applications to preoccupy phone users.

There is the problem, it’s the apps. It is a solvable problem. Just as it is possible, without inviting death and destruction, to talk to a (non-distracting) passenger while driving a car, it is entirely possible to talk on a cellphone while walking. Many who have managed to do so without winding up in emergency rooms have the solution: don’t be accessing travel agencies and restaurant menus, just talk. Furthermore, do not give your cellphone number to anybody but your children and a few very good friends. They do not create angst while you are walking/talking, and will also understand that you turn the thing off when you get home. Anybody else can darn well call the land line and leave a message. The fact that addiction to electronic wizardry and perpetually multi-tasking with it is a fairly recent phenomenon probably explains another interesting discovery:

Mr. Nasar supervised the statistical analysis, which was done by Derek Troyer, one of his graduate students. He looked at records of emergency room visits compiled by the Consumer Product Safety Commission.

Examples of such (hospital) visits include a 16-year-old boy who walked into a telephone pole while texting and suffered a concussion; a 28-year-old man who tripped and fractured a finger on the hand gripping his cellphone; and a 68-year-old man who fell off the porch while talking on a cellphone, spraining a thumb and an ankle and causing dizziness.

Young people injured themselves more often. About half the visits Mr. Troyer studied were by people under 30, and a quarter were 16 to 20 years old. But more than a quarter of those injured were 41 to 60 years old.

Over 60? Except for the unfortunate gentleman strolling off his porch, we don’t event merit inclusion in the data. This may add up to one benefit of being too old to deal with the technological wonders of cellphone apps, and tending to use the cellphone as a phone. The Times article, highly recommended reading for all ages, is full of interesting factoids and neurological rationale. But much still boils down to the old can’t-walk-and-chew-gum adage.

“Walking and chewing are repetitive, well-practiced tasks that become automatic,” Dr. Gazzaley (Adam Gazzaley, a neurologist at the University of California, San Francisco) said. “They don’t compete for resources like texting and walking.”

Further, he said, the cellphone gives people a constant opportunity to pursue goals that feel more important than walking down the street.

“An animal would never walk into a pole,” he said, noting survival instincts would trump other priorities.

There could be a message here. Perhaps it is that the goal, or at least the top priority, of walking down the street should be to get to your destination in one piece. If you skip the apps and keep your eyes open for texting drivers at cross streets, it is entirely possible for someone of any age to accomplish this task — while talking on the cellphone.

Driven to Distraction – Pedestrians, Too, Are Distracted by Cellphones – Series – NYTimes.com.

Doctors making house calls? An old idea whose new time has come

Could house calls make a comeback? It’s already happening. The University of California at San Francisco, for one success-story example, started the UCSF-Mt. Zion Housecalls Program in 1999 with a philanthropic gift. Its original goal was to teach medical students about home care, but with the exploding need for primary care for homebound elders it has evolved into filling that need throughout San Francisco — while still teaching the new generation about house calls.

In an article in the San Francisco Chronicle, staff writer Victoria Colliver details some of the many advantages that such programs have.

June Hagosian’s brain tumor has made it difficult for the 77-year-old San Francisco woman to leave her house in recent years, keeping her mostly confined to her bed.

For someone like Hagosian whose medical needs require frequent doctor visits, that would usually pose a problem. But because of a program run by UCSF, the doctor comes to her. She has had to leave her bright yellow home in the Richmond District to go to the hospital just three times in the past seven years.

“This program has been so wonderful,” Hagosian said during a recent home visit with her physician, Rebecca Conant, director of UCSF’s Housecalls Program. “I wish everyone could have it.”

Conant, who had just 15 patients when she took over the program in 2001, is one of five part-time UCSF physicians who spend all their clinical time outside the office, traveling from home to home visiting frail and elderly patients. Housecalls currently serves nearly 100 San Francisco residents and has an eight-month waiting list.The Housecalls physicians visit patients whose conditions make it so hard for them to go to the doctor’s office that they might otherwise put off seeking medical care. By then, they would be so sick they would need an ambulance and end up in a hospital emergency room. The program takes patients regardless of whether they have insurance or an ability to pay, which separates it from private practices that offer home visits as a convenience but at an added cost.

UCSF’s 10-year-old Housecalls Program is an old idea that has gained new traction. Both the House and Senate versions of the health reform bills contain proposals to examine whether home-based care improves the health of chronically ill patients and saves the government money by reducing hospitalizations and ER visits.”There’s no question there is both a medical need and substantial cost savings to the Medicare program,” said Constance Row, executive director of the American Academy of Home Care Physicians.

The Department of Veterans Affairs’ Home-Based Primary Care program, which has been operating for more than two decades, has showed a 24 percent reduction in costs for those patients, and some studies suggest savings as high as 40 percent, Row said.

UCSF’s Housecalls Programs operates on an annual budget of $300,000, almost all of which is devoted to physician salaries. That’s an average cost of $3,000 per patient, which does not include the cost of hospital care when needed. Medicare spends a national average of $46,412 per patient over the last two years of life, when patients typically have several chronic illnesses, according to researchers from the Dartmouth Institute for Health Policy and Clinical Practice.

But new technology – the ability to X-ray patients using portable machines, conduct blood tests and provide other services using mobile devices – allows doctors to offer a much higher level of care in the comfort of the patient’s home.

Conant, an associate clinical professor at UCSF, said she uses mobile devices to aid in her patient care, but she finds home visits offer other advantages like allowing her to see patients’ physical environments, meet their caregivers and better understand what kind of care they need.

“Not only does that improve medical care, but it’s based in reality,” she said.

The UCSF program is not the only home-based primary care program in the Bay Area. Kaiser Permanente, for example, serves some 370 members in San Francisco as part of its 13-year-old Community Care Program, which is handled by physicians, nurse practitioners and social workers.

Reinstituting and reinforcing in-home care, considering the significantly improved care for patients and the reduced cost to the taxpayer, would seem a no-brainer. But brains are losing out to politics a lot these days.

via UCSF program shows house calls’ time returning.

Doctors, lies and half-truths about dying

Is it painful? Will I be okay? Do I have any options? It’s hard to get answers to the first two of those questions about life’s end unless you know a really good psychic.  But as to the last one: Yes. The problem is, no one wants to talk about them.

When they do talk about them, medical professionals ignore reality, dismiss those with whom they disagree, and stop little short of outright dishonesty. For confirmation of this fact you are welcome to skip the next few paragraphs, which are included for the sake of trying to report facts while still a little angry.

A recent panel discussion at the Commonwealth Club of San Francisco was billed as a debate on the ethical issues of making end-of-life decisions. “A Good Death: Intersection of Policy and Practice” featured four experts in end-of-life policy and care. The focus was on palliative care, which has been the Big New Thing in medicine for the past decade or so. Palliative care — read: address the symptoms and keep the patient as pain-free as possible — has been around since about the beginning of time. Someone figured out, though, that if you gave it a fancy name and made it a medical specialty, which it now is, you could encourage doctors to concede that dying is part of the process and that dying patients might be better off, occasionally, if they were not treated to death. This was a step in the right direction.

The discussion, moderated by Steven Z. Pantilat MD, Professor of Clinical Medicine at the University of California San Francisco and Founding Director of the UCSF Palliative Care Program, addressed all of the proper, traditional issues: the importance of having advance directives, the need for open conversations with family and loved ones, the significance of cultural diversity around the end of life. The issues of hastened dying and physician aid-in-dying, of concern to many in the audience according to unscientific exit interviews conducted by several of us, were firmly brushed aside. A majority of Californians favor legalizing physician aid-in-dying and would want that palliative choice for themselves, but that’s what no one will talk about.

Panelists included Judy Citko, J.D., Executive Director, California Coalition for Compassionate Care , Sharon Fernekees-Jeans, Licensed Clinical Social Worker; Manager of Social Work Services and Spiritual Care, Eden Medical Center, Castro Valley, CA. and Kathe Kelly, R.N., B.S.N., O.C.N. City of Hope Nursing Research & Education, Duarte, CA.

“There really is no ‘good death’,” Pantilat said, likening life to a plane trip in which there is intense focus on the take-off (birth), followed by life experiences as the trip and concluding with attention needed for the landing at death. “The medical system wants to keep us aloft forever, with a bias toward prolonging life at all costs,” he said. Palliative care is in response to this philosoophy, which has led to “a source of suffering rather than the relief of suffering. In 2000, it was offered in one in five hospitals; now it is one in three.” Citko, explaining that “people are dying differently than in the past,” said that “today, most people have multiple chronic conditions.” Palliative care addresses this by allowing for curative treatment, as opposed to hospice care which requires forgoing curative treatment.

Panelists talked extensively about the need for advance directives and for conversations about medical treatments and end-of-life wishes.

Then came the audience questions. A number of sincerely posed questions (I read several of them) about aid-in-dying, or hastened dying for those who are near death and might wish to opt out of further suffering, brought this dismissal from Dr. Pantilat: “Regardless of what you say, if they have good care people don’t want that option.” This is simply not true. For 10 years the people of Oregon have shown that they want that option. In a poll taken when Californians were trying to pass a Death with Dignity law, despite well-funded opposition from the California Medical Association (to which a tiny percentage of physicians actually belong) and the Catholic Church, showed that a large majority of Californians want that option.

Citko, along those same lines, commented that there was “an undercover movement” afoot addressing aid in dying. I consider Citko a friend and I admire her expertise, but I had a Joe Wilson moment there. A long-time board member and committed volunteer with Compassion and Choices of N.CA, I am part of no undercover movement. Compassion and Choices is a widely respected nantional nonprofit, absolutely above ground and law-abiding. Among other things, we offer free consultation and support to dying individuals who want to know their options.

Recently I visited a comparatively healthy 93-year-old man who had called Compassion and Choices. He had had gall bladder surgery a few weeks earlier. “I will not go back to the hospital,” he said. “I’ve had a good life, and I want to have a good death.” I talked to him about his legal options should a life-threatening event recur. Shortly thereafter his daughter, a nurse who had met with us and taken notes, sent me an e-mail that sums up why we Compassion and Choices volunteers continue to work for this cause.

“You were like water for a thirsty man,” she wrote. I believe, despite Dr. Pantilat’s assertion that it does not exist, this man will have a good death. I wonder why so many people out there want to deny their fellow creatures such a small, humane thing.

Leaving Cancer Alone

We don’t talk a lot about not treating cancer. But as mentioned recently in this space, leaving it the heck alone is an option that merits consideration, particularly in the case of breast and prostate cancers detected very early on.  Now comes further news, reported by New York Times health writer Gina Kolata, of studies showing that some other cancers might also go away by themselves.

Call it the arrow of cancer. Like the arrow of time, it was supposed to point in one direction. Cancers grew and worsened.

But as a paper in The Journal of the American Medical Association noted last week, data from more than two decades of screening for breast and prostate cancer call that view into question. Besides finding tumors that would be lethal if left untreated, screening appears to be finding many small tumors that would not be a problem if they were left alone, undiscovered by screening. They were destined to stop growing on their own or shrink, or even, at least in the case of some breast cancers, disappear.

The Times article cites studies of testicular, cervical, kidney and other cancers that suggest some, left untreated, might simply go away; the trick now is to begin identifying which these would be.

I don’t know anyone who would opt out of treatment when it is likely to offer restored health. But especially for older populations, the choice of not treating a small cancer could be more frequently and seriously discussed.

Cancer cells and precancerous cells are so common that nearly everyone by middle age or old age is riddled with them, said Thea Tlsty, a professor of pathology at the University of California, San Francisco. That was discovered in autopsy studies of people who died of other causes, with no idea that they had cancer cells or precancerous cells. They did not have large tumors or symptoms of cancer. “The really interesting question,” Dr. Tlsty said, “is not so much why do we get cancer as why don’t we get cancer?”The earlier a cell is in its path toward an aggressive cancer, researchers say, the more likely it is to reverse course. So, for example, cells that are early precursors of cervical cancer are likely to revert. One study found that 60 percent of precancerous cervical cells, found with Pap tests, revert to normal within a year; 90 percent revert within three years.

And the dynamic process of cancer development appears to be the reason that screening for breast cancer or prostate cancer finds huge numbers of early cancers without a corresponding decline in late stage cancers.

If every one of those early cancers were destined to turn into an advanced cancer, then the total number of cancers should be the same after screening is introduced, but the increase in early cancers should be balanced by a decrease in advanced cancers.

That has not happened with screening for breast and prostate cancer. So the hypothesis is that many early cancers go nowhere. And, with breast cancer, there is indirect evidence that some actually disappear.

A sister who is six years older than I was diagnosed with breast cancer at 72, had a mastectomy and is cancer free. Six years later I was diagnosed with breast cancer, had a mastectomy and am cancer free. Last week I visited a college classmate who had been diagnosed two weeks ago with breast cancer; she had a mastectomy and is cancer free. Cancer free is good. But what if — just what if — one of those cancers might have disappeared without major surgery?

Disappearing tumors are well known in testicular cancer. Dr. Jonathan Epstein at Johns Hopkins says it does not happen often, but it happens.

It is harder to document disappearing prostate cancers; researchers say they doubt it happens. Instead, they say, it seems as if many cancers start to grow then stop or grow very slowly, as has been shown in studies like one now being done at Johns Hopkins. When men have small tumors with cells that do not look terribly deranged, doctors at Johns Hopkins offer them an option of “active surveillance.” They can forgo having their prostates removed or destroyed and be followed with biopsies. If their cancer progresses, they can then have their prostates removed.

Almost no one agrees to such a plan. “Most men want it out,” Dr. Epstein said. But, still, the researchers have found about 450 men in the past four or five years who chose active surveillance. By contrast, 1,000 a year have their prostates removed at Johns Hopkins. From following those men who chose not to be treated, the investigators discovered that only about 20 percent to 30 percent of those small tumors progressed. And many that did progress still did not look particularly dangerous, although once the cancers started to grow the men had their prostates removed.

In Canada, researchers are doing a similar study with small kidney cancers, among the few cancers that are reported to regress occasionally, even when far advanced.

One of the things we post-mastectomy women were talking about last week was how we might handle a recurrence. The reality is, as we have all already proved: you live long enough, you get stuff. Maybe someone at Johns Hopkins (or elsewhere; Kaiser San Francisco would suit me fine) will undertake a study in which older women with small breast cancers can opt for “active surveillance” rather than major surgery. Should I qualify, I would enroll. To this admittedly untrained and unscientific survivor it seems a study whose time has come.

Cancers Can Vanish Without Treatment, but How? – NYTimes.com.