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Death Drip: When Lifesaving Drugs Endanger Lives

October 16, 2008 8:24 AM

By Michelle Schlief, ABC News Medical Unit

Actor Dennis Quaid plays Ernie Davis’s coach at Syracuse University in his new movie, “The Express.” But offscreen, Quaid is enmeshed in a different sort of drama -- one that took a near-tragic turn last November when, as you may have heard, his newborn twins were twice mistakenly given 1,000 times the proper dose of the blood thinner Heparin, as Quaid testified before Congress recently.

Today, his work through the foundation that he founded with his wife Kimberly is bringing recognition to the problem of preventable medical errors. This is an issue that has been much on my mind lately after my own recent hospitalization.

The Institute of Medicine estimates that 100,000 people die every year from preventable hospital errors. The Quaid Foundation believes that measures like “bedside bar coding” may be what are needed to ensure that the right drug is being used at the right dose in the right patient, every time.

The idea is that before a drug is given to a patient, a health care worker would scan both the drug’s bar code and a patient’s bar-coded ID bracelet that links them to their computerized medical record. A central computer then compares the two, and if there is a problem the health care worker investigates.

What happened to Quaid’s family was the result of a misread label. But The Quaid Foundation’s push for bedside bar coding has the potential to prevent another kind of common medical mistake.

I recently underwent surgery to put two screws in my fractured ankle. While I was awaiting the surgery, I had a terrifying allergic reaction.

It was just after midnight, and the evening nurse had just started me on an IV drip. At first, I felt my guts knotting up and I tried curling up to get more comfortable. I think I fell asleep for a moment, because suddenly I was jolted awake realizing that I couldn’t feel my feet or my hands.

The world seemed to be running in slow motion. My mind started playing tricks on me and I felt like I was somehow outside of my body watching what was going on -- a classic anxiety symptom.

Then I heard my breathing: It was labored and rough, like I was having an asthma attack. I convinced myself to ignore everything else and just to sit up and get my breathing under control. When I realized it was only getting harder with each breath, I finally gathered the presence of mind to call for help.

I'm allergic to penicillin and had developed hives in response to another antibiotic the doctors had tried me on. So I later found out that they decided to try me on vancomycin, an antibiotic delivered by IV. The reaction I had is a form of non-classical allergic response called “red man syndrome.”

For some people, like me, the antibiotic causes mast cells to dump all their histamine into the body. It’s similar to a classic anaphylactic allergic reaction. For me, it resulted in a dangerous drop in blood pressure and swelling of my airway. In rare instances, it can be fatal.

Luckily for me, once they stopped the IV and gave me an antihistamine, I got better. Sometimes slowing down the rate at which the vancomycin is delivered prevents the reaction from happening, but some people have the reaction even at the slower rate of delivery.

Of course, I don’t think that anyone could have predicted that this would happen to me. But even up until the point that I was going into the operating room the next day for my surgery, the bag of vancomycin was still hanging on my IV poll. I had to keep explaining to every new team caring for me what had happened, and that although I was still on an IV for fluids I shouldn't be given the antibiotic.

So I am making a strong mental note to continue to tell all my doctors for the rest of my life about this. I hope that's enough, but I would feel even better knowing that if I ever forgot or was brought in unconscious, that there would be a bar-coding system in use that tied into my electronic health record -- so that if anyone ever tried to give me vancomycin again, a loud alarm bell would go off.

As Quaid told reporters for the Wall Street Journal’s health blog: “In my line of work, if I make a mistake, we have take two. …If you’re a health-care professional and make a mistake, you could kill somebody.”

October 16, 2008 | Permalink | User Comments (5)

Losing Grandma, One Memory at a Time

October 15, 2008 1:46 PM

By Joanna Schaffhausen, ABC Medical Unit

I got married this year, an event my grandmother had been praying for since I turned 16. Thrilled it was here at last, she dressed in her smart purple suit and attended the ceremony.

At the reception, I went to greet her. “Look at you all dolled up,” Grammy exclaimed as she stroked my big, white dress. “What’s the occasion?”

“I got married,” I replied.

“You did?” she asked, sounding hurt. “How come I wasn’t invited?”

In my family, we have to laugh or else we’d cry. These surreal conversations have been happening more and more over the last eight years as my grandmother slowly loses her memory.

What baffles the family is why fate seems to have chosen Grammy for this long, cruel goodbye. At nearly 88 years old, she is in otherwise reasonably good health. Her siblings survived to ripe old age without any serious memory problems. Her sister and roommate Kathryn, who is closing in now on 103, is still much sharper mentally.

Why should dementia grab my grandmother and not the others? We search the family history for clues.

Kathryn was -- and still is -- more mentally active than my grandmother. She read novels; my grandmother preferred People magazine. Kathryn acted in plays, painted pictures and was the belle of the ball at her senior center in Alaska. My grandmother spent most of her nights with my grandfather watching television in their living room.

Could Kathryn have helped dodge dementia by staying mentally fit?  Some brain experts think so.

Neurologist Gary Small at UCLA is a firm believer in the “use it or lose it” philosophy of brain health. Indeed, studies consistently show that people who are more mentally active -- through social visits with friends, hobbies and daily brain games such as a crossword puzzle -- have less cognitive decline over time.

Small’s latest research suggests that even simple Internet searches may help keep our brains active and healthy in old age.

In the study, brain scans showed that when middle-age and senior adults performed Internet searches, it activated many different areas of the brain, including those involved in memory, decision-making and reasoning. But the activation patterns only occurred in the brains of seniors who were used to surfing the Net. When researchers tested “Net naive” subjects, their brains showed an activation pattern similar to the one seen when people are reading.

Maybe, I think, if we had just been able to convince my grandmother to use the computer we gave her years ago, she might not be disappearing into a mental fog.

Concern about how to avoid dementia is on the rise as the population ages. Companies now market brain games designed to keep us mentally fit. Neurologists are divided on whether these mental workouts actually help, because so far no study has been able to establish firm proof that brain teasers and a heavy social calendar will keep dementia at bay. The research is suggestive but not conclusive.

Scientists are still looking for answers. Both my grandmother and Kathryn are taking part in a national longevity study in which researchers probe volunteers' family history and study their DNA to search for clues about how they have lived so well for so long.

Kathryn hated the blood test (she has difficult veins), but she’s eager to be part of scientific history. “I like to be in on things,” she said, a life motto that may well help explain her advanced years.

As for my grandmother, she’s not sure why anyone would want to study her. “I’m not very old,” she insists.

“Grammy, you’re nearly 88,” I tell her often.

She’s always horrified. “Nonsense!” she says. “I’m not a day over 70.”

And again, we laugh through the tears.

October 15, 2008 | Permalink | User Comments (12)

Incoming! New Hope in the Battle Over Baldness?

October 13, 2008 1:54 PM

By Kirk Fernandes, ABC News Medical Unit

Genetics researchers are getting closer to the heart of a problem that has plagued millions of men (and women) for thousands of years -- male-pattern baldness.

Chuckle as you might, it's an issue that's close to my scalp. 

For several years a war has played out upon my skull. I've watched over time the retreat of the front lines. At the same time, invaders have been encroaching from the rear -- a sneak attack I only recently noticed after getting a rare photographic glimpse of the back of my head.

I may soon have to call for reinforcements -- the minoxidil contingent from the Rogaine region.  But I suspect I'll wait until the last minute, until defeat is certain … because I refuse to admit the sad truth of what is to come.

There will be no victors in this war; all that will remain is an oval flatland of dry, denuded skin. 

But there is some news of hope from the forward command post -- the capture of an enemy gene-ral.

A group of European and Canadian researchers, along with pharmaceutical company GlaxoSmithKline in Pennsylvania announced Sunday the discovery of a gene that increases the risk of male-pattern baldness. (A second group of researchers from Germany and Australia, working independently, also announced the same find.)

This isn't the first gene to show an association to the condition. A previously known gene on the X chromosome with a role in hormone reception has already been associated with male-pattern baldness. In fact, it's often used as an example in biology class of a gene that men inherit from their mother, because the single X chromosome in a man comes from his mother.  (And that's also why your father's head of hair gives you little information about whether you're prone to male-pattern baldness; your mother's father is a better person to watch.)

In any case, the researchers report in Nature Genetics that when a person has certain variations of both the known gene and the newly discovered one, his (or her) risk of male-pattern baldness increases sevenfold. In fact, the study showed that among men with both gene variants, 14 percent are at "very high risk of androgenic alopecia" -- the fancy phrase for male-pattern baldness -- and 50 percent are at "moderate risk," said Tim Spector, one of the researchers and a genetics professor at King's College London, via e-mail.

In terms of the relative risk, if you have neither of the two genetic variants you can be about 95 percent sure you won't suffer the hairless fate, added Spector.

They made this determination by examining 1,125 men as part of the CoLaus project in Lausanne, Switzerland -- a study of genetic factors related to cardiovascular and metabolic problems in whites.  (There is some correlation between male-pattern baldness and these types of disorders.)

Still, there's no absolute certainty in these numbers … they're probabilities. And that's one of the problems with genetics research and gene variants, they rarely give us the whole picture of what's going on inside our bodies. And because the study sample included just white men, it's not exactly clear whether the results can be applied to other ethnicities.

The fact of the matter is that we see these kinds of gene discoveries all the time. They come in two varieties: Researchers have found the first gene associated with (insert disease here), or, researchers have found another gene that also seems to play a role in (insert disease here).

These developments are often newsworthy, but it's always important to understand that any discovery is just a step on a staircase scientists climb all the time in order to advance our knowledge of health and medicine. It's not going to effect immediate change.

Sure, younger men could now assess the potential risk of future male-pattern baldness by getting tested for the genes. But then what?

The scientists do speculate in the report that if they can figure out what this newly discovered gene variant does and how it works there might be hope for gene therapy drugs applied directly to the scalp.

But it would be "many years before novel therapies," said Spector.

So, for now, the hirsute hostility continues atop my noggin, and the noggins of so many others. All we can hope for is that our follicles will stand their ground like Spartans of the scalp.

October 13, 2008 | Permalink | User Comments (7)

Distilling Between Scent and Sensibility

October 10, 2008 6:30 AM

By Audrey Grayson, ABC News Medical Unit

Every day of my life, I am swarmed with advertisements for products that promise to make me look younger, feel younger, reduce my fine lines and wrinkles, shrink my thighs or help me lose 10 pounds instantly. I hear these promises so often, it's all become white noise.

That is until I came across a new claim I had never heard before: “Ageless Fantasy perfume can make you smell eight years younger!”

For $120 a bottle.

New York perfumer Harvey Prince released the new  Ageless Fantasy  scent in August, and he is promoting it as "the world's first anti-age perfume."

Kumar Ramani, the CEO of Ageless Fantasy Inc., says these claims are based on hard scientific evidence.  The basic idea behind the product, he says, is that  smell can elicit emotions and  some of our earliest memories.

“The odor-detecting ability [of our brain] is extremely acute and shapes our social interaction in a way we aren’t consciously aware of,” Ramani explained. “There’s enough proof out there that the sense of smell can trigger our emotions.”

So how does understanding this fact allow a fragrance maker to bottle the essence of youth?

According to Ramani, it all started with the idea that there is such a thing as an “old lady” scent.

The idea of “old lady” scent is not new to me. As soon as he mentioned it, I recalled a multitude of elevator rides wherein I was trapped with an older woman wearing what can only be described as the heavy, suffocating scent of “old lady perfume.”

Ramani said perfume makers have actually nailed down the essence of “old lady perfume” to the scent of … rose.

“Something occurred to me about the rose scent when we were discussing it with the fragrance industry, and they were saying rose is known as an older person smell, and the perfumes based on the rose scent always end up in the hands of older people,” Ramani said. “So if rose smell is an old lady smell, then what is the opposite of rose? What smells like a young lady?”

Ramani turned to soft science for his answer.

The scent of “Ageless Fantasy” came about following a semiscientific study to see if men could identify which scents they associated with younger women while they were blindfolded.

The “study” -- and I use this term loosely -- conducted by the Smell and Taste Research Foundation in Chicago involved 75 blindfolded men who were presented with different scents and asked to estimate the age of the woman who would wear such a perfume.

From a purely scientific standpoint, a 75-member sampling of men does not constitute a serious clinical study. But  using this research, the Harvey Prince perfume company was able to come up with a scent combination that supposedly reeks of female youth: a mixture of pink grapefruit, mango, pomegranate, jasmine and musk.

At face value, I have two issues of concern with this research.

One: Unfortunately, in the real world, men will be basing their evaluation of me not just on the perfume I’m wearing, but what my face looks like, how I’m dressed, what kind of body language I use and maybe even the color of my hair. So if I look like I’m 35 years old, dress like I’m 35 years old and act like I’m 35 years old, I hardly believe that my youthful scent will be enough to convince a man that I’m younger than I really am.

Two: If scent is really so strongly associated with personal memories and experiences, then wouldn’t it also be true that each and every scent affects  each person differently? How is it possible that there could be one scent that smells “youthful” to everyone?

Despite my natural skepticism, I decided to try the perfume for myself and see if it had any effect at all.

I must admit that upon first sniff, the perfume did actually smell young to me -- like Clinique Happy (a scent I  wore often in middle school) but less citrus-y, more fruity. I smelled good, that I knew, but younger?

Three days went by without anyone noticing my new signature scent. Then, last Saturday, something finally happened.

I was in the car with an old girlfriend of mine when she turned to me abruptly and said: “Are you using a new shampoo or something? You smell like the Victoria’s Secret shampoo I used to buy when I was in middle school.”

While this may not have been the reaction to the perfume that the manufacturers were looking for, it was way better proof of concept for me than any other “study” they could have pointed me to.

October 10, 2008 | Permalink | User Comments (4)

Inside the Mind of Celebrity Stalkers: Not Your Average Kind of Crazy

October 09, 2008 9:30 AM

By Joanna Schaffhausen, ABC News Medical Unit

Famous people, be they movie stars, professional athletes or politicians, all have special talents or good looks that draw us to them. But it turns out they attract a special kind of stalker as well -- the psychotic kind.

I’ve never longed to be famous; too much attention makes me uncomfortable. So it was somewhat surprising in my junior year of college when I discovered I had a stalker of my very own. His name was Dan, and we went out on exactly one date. He was polite but a bit strange. Over dinner he demonstrated his ability to speak Klingon, the made-up language from "Star Trek," and he had trouble keeping eye contact.

When he asked me out again, I put him off, claiming to be too busy. But then I couldn’t shake him. He started turning up outside my dorm and my classes. Uncomfortable, I always said hello but moved away quickly, making more excuses.

Dan started watching my dorm room and tracking my comings and goings. He called every few minutes, and if I happened to be on the phone with someone else, he got angry and made threats to “kill any guy” who was interested in me. I told him to leave me alone but he kept calling, begging for another chance.

When he followed me home from college to my parents’ house, I got scared. We called the police and gave them Dan’s information. They promised to talk to him, and thankfully, it seemed to work. I never heard from him again.

Dan spooked me, but according to new research, I shouldn’t have been too worried. Psychologists say that most stalkers of everyday people are simply socially inept or suffering from depression.

But celebrity stalkers are more likely to suffer from serious mental illness, Australian and British researchers reported at the 19th International Symposium on the Forensic Sciences on Tuesday in Melbourne, Australia. Paul Mullen, a forensic psychiatrist at Monash University and the Victorian Institute of Forensic Mental Health in Victoria, Australia, and his colleagues examined files of disturbed individuals who had stalked members of the British Royal Family.

Their results are detailed in a report in the British magazine The New Scientist.

“The Mullen team examined in detail the files of 250 of the remaining 5000 people judged to be true stalkers. About 80% had a serious psychotic illness, including schizophrenia, delusions and hallucinations, they found," according to the report.

The finding contrasts sharply with people who stalk nonfamous people.

"Typically a fifth of stalkers have some sort of serious or severe psychotic disorder," says forensic psychologist Rosemary Purcell of the University of Melbourne, Australia.

It makes some sense if you stop to think about it: People who stalk celebrities are typically basing their affections on imaginary connections, having never personally interacted with their target. Dan and I at least knew each other face-to-face.

But the increased level of psychosis in celebrity stalkers also makes them more dangerous. Mullen’s research finds that stalkers are responsible for roughly half of attacks on VIP targets, including the most serious assaults.

Since my experience with Dan, I’ve had the chance to read "The Gift of Fear" by Gavin De Becker, a security advisor for the government, large corporations and celebrities. The book is considered a must-read, especially for young women.

De Becker writes that women are socialized to be friendly at all times, even when it places their personal safety at risk. It’s a mistake I made many times with Dan. I didn’t want to seem rude. Instead of saying “no, I am not interested in going on another date with you,” I made excuses that gave him hope for a continued relationship.

Even when he started to scare me, I kept answering the phone and talking to him on the street. De Becker advises women who are being stalked to keep a record of phone calls or e-mails but not to answer them. If you ignore 20 calls but answer the next, it teaches your stalker he has to make 21 calls to get your attention. And for many of these people, negative attention is just as good as real affection.
For celebrities, the situation is different. They just have to smile for the camera, and some stalkers take it as encouragement.

In the "The Gift of Fear," De Becker recounts the case of Michael Perry, who stalked singer-actress Olivia Newton-John in 1983. Perry was already known to De Becker and law enforcement officials when he went on a murderous rampage in Louisana, killing five members of his family. Perry had written letters to Newton-John, claiming she was responsible for dead bodies rising from the floor of his home. De Becker feared she would be Perry’s next target.

While watching Newton-John’s home to see if the escaped madman would turn up there, De Becker found evidence of two additional stalkers on the property. But Perry never showed. Instead, he was apprehended in Washington, D.C., where authorities believe he was stalking another one of his famous targets, former Supreme Court Justice Sandra Day O’Connor.

Obviously, VIP targets need the help of professionals like De Becker. But his advice is just as valuable for everyday people. Trust your instincts. If you sense danger, heed that signal and remove yourself from the situation as soon as possible. Politeness will not help you if your life is on the line.

October 9, 2008 | Permalink | User Comments (22)

Herbal Remedy Works for Depression -- but Only in Germany

October 08, 2008 6:30 AM

By Michelle Schlief, ABC News Medical Unit

I hope you'll trust me that I've had enough personal experience with depression, including supporting and helping friends and family who suffer from the disorder, to say that I don't find it to be a laughing matter.

But I find myself really wondering about this new study that looks at St. John's wort, a popular herbal remedy for depression. The good news is that according to this new analysis, it appears to work just as well as some prescription drugs for major depression (the most serious form); the bad news (for most of us) is that you apparently need to be German to experience the effect.

No fooling.

According to Klaus Linde of the Technical University in Munich, and the lead author of the analysis, "Trials from German-speaking countries have clearly more positive effects, both compared to placebo and standard antidepressants, than trials from elsewhere." The remedy's effectiveness in other countries remains uncertain, he said.

Holy glockenspiel, Batman!

Immediately, I'm wondering if my descendants can reap any benefit out of my one-quarter German-ness. Maybe I'm finally finding the real perks of having that surname that nobody ever gets quite right.

But I'm getting way ahead of myself. This analysis that I'm talking about is actually a meta-analysis from the Cochrane Collaboration, an international group that evaluates health-related research.

Meta-analyses examine the results of multiple studies that have set out to address similar questions. You might, for instance, want to see the results of a meta-analysis when you have several smallish studies with results that aren’t significant and seem to contradict one other, or have otherwise proved inconclusive. By pooling the data, meta-analyses allow you to come to more accurate conclusions based on all of the data.

But I know what you're thinking -- and yes, the classic problem with meta-analyses is the old garbage in, garbage out. A good meta-analysis of badly designed studies will still result in bad statistics. And although the Cochrane Collaboration is well respected and discriminating in its analysis, I still have my questions.

Is this due to a placebo effect -- and if so, why are Germans more susceptible?

Research supports the idea that the placebo effect is real. And recent data suggests that beliefs can affect the strength of the effect -- for instance, volunteers had greater placebo-based pain relief when they believed that their (sugar) pills were expensive. Their bodies seemed to really think that they were getting what they’d paid for. So perhaps the way these studies are conducted in German-speaking countries lends itself to stronger beliefs about the effects of pills?    

Or is this a heritable effect based on having German ancestors -- for instance something genetic or epigenetic?

Different people respond to different medications and treatments for depression -- this is almost certainly because what we call depression is actually a collection of different disorders with different underlying psychological and biological mechanisms.

And more than a few diseases have been linked specifically back to our ancestors. Sickle cell anemia is more common in those whose ancestors lived in Africa, the Mediterranean and the Arabian Peninsula; heart attack risk due to a particular genetic variant more common in African-Americans than in European Americans; and Parkinson’s disease is twice as likely to develop in a subset of people whose ancestors are from China. Interestingly, it's believed that most of those with the mutation are descendants of a common ancestor.

Or maybe this is an artifact of German culture -- it's unlikely, but could they be using a different standard of normality?

If my melancholy is your business as usual, then I can see how a discrepancy could emerge.

Or perhaps there is a systematic design flaw in either the German or the non-German studies?

The authors have tried to control for all variables reported among experiments, but there could easily be something besides living in a German-speaking country that everyone is overlooking.

The bottom line for me is that St. John's wort has already been shown to be effective in treating mild and moderate depression, regardless of where your ancestors called home. I'm not, however, convinced that it's the perfect therapy for everyone with major depression. But if St. John's wort helps anyone who can't or won't or who just isn't interested in taking prescription medication for depression -- if it serves as a first step or even the only necessary step for anyone who isn't comfortable or able to talk with a mental health professional -- then I'm for it.

But as with any major lifestyle change, it's critical to consult your doctor before proceeding.

And like other dietary supplements, St. Johns wort isn’t regulated by the FDA. The daily dose of extract tested in the analyzed trials was between 500 and 1,200 milligrams. And as you know, there can be huge differences between different brands. 

Finally, keep in mind that what works for somebody else may not work for you. Many other options exist including talk therapy.

What do you think?

October 8, 2008 | Permalink | User Comments (4)

The Joy of Overeating

October 06, 2008 6:30 AM

By Audrey Grayson, ABC News Medical Unit

I like to stop at the local bakery for coffee on my way into work. Usually I'll resist the display of baked goods, but I recall not too long ago falling victim to a monstrous muffin. By the time lunch hour rolled around, I had that familiar tummy ache you remember from childhood when you ate too many treats -- full but unsatisfied, accentuated by a dull ache.

My gastrointestinal disgruntlement shouldn't have come as a surprise, given that the muffin was half the size of my head.

There's no question that muffins, cookies and just about every other type of food you can order these days come super-sized, but new research indicates even the seemingly classic recipes we use at home are provoking us to eat big.

Researchers from Cornell University studied recipes in “The Joy of Cooking” -- one of this country's most published cookbooks and the cornerstone of many cooks' libraries. The research looked at 18 recipes that have been published in each edition  of "The Joy of Cooking" dating back to 1936.  They found that 14 of the 18 recipes had increases in calories over time, and the difference wasn’t small. 

The overall calories in the recipes increased by 35 percent  --  from 1,922 to 2,489.  The calories per serving also increased for 17 of the 18 recipes for an average of an extra 77 calories per serving.   

Researchers say about 38 percent of the increase in calories comes from using more fattening ingredients and 62 percent of the increase comes from larger portion sizes.

This isn’t the first time someone noticed the expanding portions.

Lisa Young, an adjunct professor in the Department of Nutrition, Food Studies and Public Health at New York University, has spent much of her career studying how the widening of portion sizes over the years has contributed to our widening waistlines.

In 2002, Young published a study in the American Journal of Public Health which found that identical recipes for cookies and desserts featured in newer editions of the  "Joy of Cooking"  specify fewer servings than editions from 20 years ago, meaning that portions are expected to be much, much larger.

“The identical brownie recipe in the 1997 edition of the “Joy of Cooking” yields 16 brownies, and the 1975 edition yielded 30 brownies  -- hence, each brownie is almost twice as big,” Young explained.

And according to Young, the portion-size explosion doesn’t end with the cornerstone cookbook.   

In her book “The Portion Teller Plan,” Young wrote that “in the course of just three years -- between 1984 and 1987 -- the chocolate chip cookie recipe on the back of the Nestlé’s Toll House Semi-Sweet Chocolate Morsels package scaled down the number of cookies it makes from 100 to 60.”

To put this in perspective, it's as if any time you stop at the bakery for a muffin, cookie or bagel, you will probably be handed a treat that is nearly twice the size it would have been only 15 years ago.

Dr. David Katz, associate professor of public health at Yale University, said that he was not surprised that cookbooks such as the “Joy of Cooking” have increased the portion sizes of popular recipes over the years.

“The average dinner plate has increased in diameter roughly 40 percent since World War II,” Katz explained. “It stands to reason that if plates are bigger, [portions] are bigger to fill them. I am certainly not surprised that overeating does not stop at the threshold to one's own home.”

Nowadays, many nutrition experts are careful not just to urge their patients to cook more at home, but to be aware of the portion size and calorie content of the recipes they are cooking as well.

“I tell [my patients] that healthy cooking needs to start at home and this involves ingredients, cooking methods and perhaps most important -- portion size,” said Keith-Thomas Ayoob, associate professor in the department of pediatrics at the Albert Einstein College of Medicine in the Bronx, New York. “I tell them to push the veggies way more than they do now. People balk at smaller, computer mouse-sized portions of meat but they forget that the plate doesn't have to be empty, just occupied with more whole grains and veggies.”

From now on, I think I’m going to bring half of my homemade muffin to work, and save the rest for later.

What do you think? Are portion sizes out of control? Do you pay attention to portion sizes for family meals?

October 6, 2008 | Permalink | User Comments (14)

Death and Deception on the Internet

October 03, 2008 9:04 AM

By Joanna Schaffhausen, ABC News Medical Unit

How can you tell if someone is lying over e-mail or on the internet? The temptation is apparently great, and new research suggests people lie more easily over e-mail than they do with a pencil and paper.

Luiba Belkin, an assistant professor of management in the College of Business and Economics at Lehigh University, tested truthfulness in 48 MBA students. Belkin and her colleagues gave the students $89 to divide among themselves and another fictional party, who  knew only that the dollar amount fell somewhere between $5 and $100.

Using either e-mail or pen-and-paper, the MBA students reported the size of the pot to the fictional party and explained how the money would be divided.

Over e-mail, students lied about how much money was in the pot more than 92 percent of the time, while those using pen-and-paper lied slightly less than 64 percent.

Something about the anonymity of the Internet appears to foster dishonesty, psychologists find.

But can lying on the Internet be considered a mental illness? Yes, according to some psychologists, who say it’s a growing problem. People desperate for attention make up entire fictional lives for themselves, only to turn around and “die” so that they can attend their own online funerals.

I wouldn’t have believed it possible … until it happened to me.

She said her name was Evie. She was a member of an internet fiction writing community I belonged to back in 2002. At the tender age of  22, she had a toddler, twin babies and a master’s degree. She connected, with other women especially, sending them pictures of her children and little presents in the mail.

Then one day, Evie sent a troubling message to the community: She was sick in the hospital with pneumonia. People sent their good wishes and for a while Evie seemed to be doing better. Her husband, Adam, even brought her laptop to the hospital for her to use.

But suddenly Evie took a turn for the worse. Her heart was failing and she slipped into a coma.

We received regular updates on her condition from Adam, who was by her side through it all. The details were sometimes horrifying. Doctors had to shock her heart back into rhythm. They gave her ice baths to relieve her fever. And worst of all, the nurses had to cut her beautiful waist-length hair.

We prayed for her, but our prayers went unanswered. Adam came online to deliver the awful news: Evie had died.

Shock reverberated through the community. How could this happen to a young, healthy mother in the prime of life?

Her Internet friends cried, wrote tributes  and donated to charities in her name. Adam answered every one of their heartfelt e-mails. And despite having a funeral to plan and three young motherless children at home, Adam appeared to be on the Internet all the time.

Whispers started in certain circles. The story didn’t seem to add up. Community members with medical backgrounds said Evie’s treatment hadn’t made any sense. The devastated husband was spending all his time online, encouraging tributes to Evie.

Skepticism grew, especially when no one could find an obituary for Evie online. Finally someone dared say it in public: We’d been duped. Evie was never sick, hadn’t died, and in fact was still with us, posing as Adam. The whole story, including the three small children and her master’s degree, was a lie.

Adam denied it, and many community members rallied around him. They said the disbelievers were horrible people for adding to Adam’s pain.

But then one astute person noticed an interesting detail in Adam’s writing style. He had a strange habit of putting a space between the last word of a sentence and the period -- like this . A check of Evie’s e-mails showed she made the same idiosyncratic punctuation error too. This seemed to prove it -- Evie and Adam were the same person.

This discovery just prompted  Evie  to adopt a new persona, her sister  Aisha,  who came online to scold everyone for doubting Evie and Adam. Aisha’s messages had the same strange spaces before the periods at the end of her sentences.

By now, the community was torn apart between those who still believed Aisha and Adam, and those who were furious with Evie for lying.

But the most bizarre twist was yet to come -- Evie herself reappeared! She claimed a stalker had stolen her laptop and faked Evie’s death, even going so far as to learn her odd punctuation style.

Few believed her story, and she was forced to leave the community. But for months afterward, every new member was suspected of being Evie writing under yet another different name. The closeness and trust that members once shared was gone, irreparably harmed.

It turns out Evie’s story is not that unusual and is part of a growing phenomenon called  Munchausen’s by Internet. Munchausen’s disease is a mental illness in which people fake being sick to get attention from doctors and nurses. Munchausen’s by Internet is pretty much the same thing, only in cyberspace, with the added bonus that sufferers can even “die” and watch people’s reactions.

According to psychologist Marc Feldman, who coined the phrase Munchausen’s by Internet,  people with the disorder frequently target communities devoted to medical issues, such as support groups for cancer patients or people with anorexia.

The communities often dissolve after the truth is uncovered. Some people refuse to believe they’ve been suckered, and the skeptics have trouble trusting again.

Now I know that Evie’s story had all the signs of a classic Munchausen’s by Internet case. Feldman lists the main ways to spot a faker:

1. The user’s e-mails or posts consistently duplicate material in other posts, in books  or on health-related Web site.
2. The characteristics of the supposed illness emerge as caricatures.
3. Near-fatal bouts of illness alternate with miraculous recoveries.
4. Claims are fantastic, contradicted by subsequent posts, or flatly disprove.
5. Continual dramatic events take place  in the person's life, especially when other group members have become the focus of attention.
6. There is feigned blitheness about crises (for example, going into septic shock) that will predictably attract immediate attention;
7. Others apparently posting on behalf of the individual (such as family members and  friends) have identical patterns of writing.

 

Have you ever been duped over e-mail? Why do you think the internet fosters deception?

October 3, 2008 | Permalink | User Comments (416)

Celebrity Feud: Does Botox Work for B.O.?

October 02, 2008 6:25 AM

By Kirk Fernandes, ABC News Medical Unit

Botox for body odor? That malodorous question wafted forth during the latest round of custody proceedings over the 8-year-old son of actress Sharon Stone and her ex-husband, Phil Bronstein.

In San Francisco Superior Court documents, the judge references Stone suggesting that her son get Botox injections to fix a foot odor problem, reports Internet gossip site TMZ.com.

Putting parental perspectives aside, we thought it would be worth taking a look at just how Botox might be used to battle B.O.

Quick refresher. Botox is the trade name for Botulinum Toxin Type A, which comes from the potentially deadly bacterium Clostridium botulinum. When injected into the body in small doses, Botox can decrease nearby muscle activity, thus treating excessive muscle contractions and overactive glands -- including, yes, sweat glands.

Even though sweat doesn't always result in odor, it turns out there is some scientific basis for Stone's belief in Botox as a cure for smelly feet.

Botox is, of course, best known for contributing to the wrinkle-free Hollywood movement, but it was originally approved by the FDA for several medical uses, including the treatment of crossed eyes, excessive blinking and cervical dystonia (a condition characterized by jerky, involuntary neck movements).

In July 2004, the FDA approved Botox for the treatment of severe primary axillary hyperhidrosis -- more easily put as "really sweaty armpits."

But, not only does Botox reduce the amount of armpit sweat, several studies suggest it also reduces armpit odor.

In the aptly named 2007 research paper "Improvement of Olfactory Profile after Botulinum Toxin-A Treatment in Healthy Individuals," German scientists (supported by Pharm-Allergan, the company that makes Botox) report a study that can only be described as scent-illating.

Here's how the research went:

Day 1: 51 volunteers got a special, clean T-shirt to wear. After 24 hours, the researchers cut out the armpit areas of the shirts and froze them in bottles. Then, participants received injections of Botox in one armpit and harmless saltwater injections in the other.

Day 7: Researchers collected a second group of T-shirts and, again, preserved the armpit areas in bottles.

Day 90: A third set of T-shirts; more bottles.

So, how did the scientists determine whether the armpits that received the Botox injections smelled better than the armpits that got the useless saltwater placebo? T-shirt sniff test -- comparing Day 1 to Day 7 and Day 90.

Nine men and nine women, selected for lack of nasal congestion, among other olfactory advantages, came forth to rate the stench of each scrap of T-shirt -- 50 scraps per person, to be exact.

Each rater came up with scores for "odor intensity" and "odor quality."

The study, published by the American Society for Dermatologic Surgery, reported that the armpits treated with Botox smelled "less intense" and "better."

While the small study sounds laughable, the research doesn't necessarily stink.

"We really admired this study," said Dr. Timothy Corcoran Flynn, medical director of Cary Skin Center in Cary, N.C., and clinical professor of dermatology at the University of North Carolina, Chapel Hill.

You get a reduction in sweating and you get a reduction in odor, said Flynn -- who typically sees patients get the injections every "6-9 months or so."

Others have tried the technique in more delicate areas. For example, researchers in Korea reported success after treating genital odor with Botox in one patient -- who received 40 injections in one session. (I suspect the first injection, at the very least, was a rather tense affair.)

With respect to Botox reducing foot-related sweating and odor, there is far less research on the subject.

Some case studies on the procedure report an improvement in sweatiness, but the tests were done on a small number of people, and even doctors who conducted those studies conclude they would like to see larger research efforts with more participants.

Still, the procedure is available and advertised, as several videos on YouTube illustrate.

As for whether even considering Botox injections for 8-year-olds with smelly feet is a no-no, that issue might have to be left to a judge's discretion for now. 

The American Academy of Cosmetic Surgery does not have a position on such use of Botox in kids, but it does have a position on cosmetic use of Botox in teenagers.

"If you were talking about a child having Botox for cosmetic reasons, we would be opposed to that," said AACS spokesman Charlie Baase.

It's not clear if Stone had recommended or encouraged other anti-foot-odor strategies with her son.

I've found a regular wash, socks and comfortable shoes usually do the trick … but I don't think my sweat glands are on overdrive, either.

What do you think of Botox for body odor? Should parents consider such a procedure for their kids?

October 2, 2008 | Permalink | User Comments (23)