Author: books

Sept. 1, 2022 – It’s hard figuring out what the road ahead will look like for a cancer patient. A lot of evidence is considered, like the patient’s health and family history, grade and stage of the tumor, and traits of the cancer cells. But ultimately, the outlook comes down to health professionals who analyze the facts.

That can lead to “large-scale variability,” says Faisal Mahmood, PhD, an assistant professor in the Division of Computational Pathology at Brigham and Women’s Hospital. Patients with similar cancers can end up with very different prognoses, with some being more (or less) accurate than others, he says.

That’s why he and his team developed an artificial intelligence (AI) program that can form a more objective – and potentially more accurate – assessment. The aim of the research was to tell if the AI was a workable idea, and the team’s results have been published in Cancer Cell.

And because prognosis is key in deciding treatments, more accuracy could mean more treatment success, Mahmood says.

“[This technology] has the potential to generate more objective risk assessments and, subsequently, more objective treatment decisions,” he says.

Building the AI

The researchers developed the AI using data from The Cancer Genome Atlas, a public catalog of profiles of different cancers.

Their algorithm predicts cancer outcomes based on histology (a description of the tumor and how quickly the cancer cells are likely to grow) and genomics (using DNA sequencing to evaluate a tumor at the molecular level). Histology has been the diagnostic standard for more than 100 years, while genomics is used more and more, Mahmood notes.

“Both are now commonly used for diagnosis at major cancer centers,” he says.

To test the algorithm, the researchers chose the 14 cancer types with the most data available. When histology and genomics were combined, the algorithm gave more accurate predictions than it did with either information source alone.

Not only that, but the AI used other markers – like the patient’s immune response to treatment – without being told to do so, the researchers found. This could mean the AI can discover new markers that we don’t even know about yet, Mahmood says.

What’s Next

While more research is needed – including large-scale testing and clinical trials – Mahmood is confident this technology will be used for real-life patients someday, likely in the next 10 years.

“Going forward, we will see large-scale AI models capable of ingesting data from multiple modalities,” he says, such as radiology, pathology, genomics, medical records, and family history.

The more information the AI can factor in, the more accurate its assessment will be, Mahmood says.

“Then we can continuously assess patient risk in a computational, objective manner.”

“It’s so much more than a physical transformation.”

Those are the words of one of my beautiful clients, and I realized they are a perfect description of my own journey as well.

I’m Elizabeth from Happy Healthy and Hot. I’m a 56-year-old double-certified health coach who helps women of all ages lose weight so they can love their bodies AND their lives. I’m passionate about showing them that it feels so good to feel so good and that it’s not just about the destination of better health, it’s about who you become on the journey.

Back in 2016, approaching my 50th birthday, I was featured as a success story here on MDA. I shared my health journey of finally clearing the cystic acne that had plagued me for decades, along with relieving severe anxiety and digestive issues. This was all a result of embracing the Primal lifestyle.

Recently I re-read that article and was moved to tears. In it, I mentioned three goals: to become certified as a Primal Health Coach, to start my coaching business, and write a book. I have accomplished all of that and so much more.

Earning my Primal Health Coach certification in 2017 took me so much deeper into the science and research that backs up this lifestyle, and gave me the tools, knowledge, and most importantly the confidence to finally start my coaching business, Happy Healthy and Hot. I offer a unique blend of mindset, nutrition and fitness, and have a knack for turning overwhelming health information into quick little tips that my clients can implement immediately and see results.

And then I wrote that book! The Happy Healthy and Hot Journal – 90 Days to Love Your Body and Your Life is the simple tool that I needed, my clients needed, and I knew other women needed to stay on track with mindset, nutrition and fitness every single day.

Something else I’m proud of is making it to the finals of the Maxim Cover Girl competition at the age of 53, competing with women in their twenties and thirties. The old Elizabeth never would have done this, but the new Elizabeth embraces challenges head on, takes inspired action, and says yes when it’s a full body yes.

A recent challenge that I’ve taken on is to give myself a gift that no one else can give me: a visible six pack for my 56th birthday. (Full disclosure: I’ve never had a six pack, even when I was hitting the gym hard in my early twenties.) Every time I take on a challenge like this it lights me up, and the confidence and satisfaction that come with reaching the goal carry over and propel me forward in other areas of my life.

And speaking of life, it gets in the way sometimes, just like it does for everyone. It’s during those times, when the sh*t is hitting the fan, that I see the true value of my health practices. The simple routines that I have in place for mindset, nutrition and fitness keep me on track no matter what is going on around me.

I am always tweaking my health and fitness routine, but ultimately it’s not that different from what I shared back in 2016. Every day starts with an early morning walk, which is so much more than exercise. It’s about getting out in nature and that valuable early morning light exposure. Next is my coffee, quiet journaling time, and a very efficient 20-minute workout that’s mostly bodyweight resistance. I walk at least 10,000 steps a day, and much more than that if I’m hiking or on the beach.

I teach my clients to “prioritize protein and produce” which is exactly what I do in my own life. It works anywhere, from a convenience store to a five-star restaurant. But my favorite place to eat is my own home, where I have complete control of the quality and preparation. There’s something very satisfying about preparing simple, delicious food with the best ingredients.

Now that nutrition comes so easily to me, I’m finding myself drawn to spending more time outdoors and reaping the benefits of natural light exposure and grounding. As I focus more on strength and endurance, my next challenge will be completing the Primal Fitness Coach Certification, to expand my knowledge and the service I provide to my clients.

The reason I keep challenging myself is simple: it feels so good to feel so good! Optimizing my health has created a positive ripple effect on every area of my life, and being able to share my journey and inspire others through social media is turning that ripple into a powerful wave.

In closing, health goals are about so much more than reaching a destination. It’s about who you become along the way. And the best way to get there is to take action with your vision in mind. This is what kept me going while I was working on my six pack. Every meal I prepared, every workout I competed, every affirmation that I spoke was done with a clear picture in my head of how amazing it was going to feel when I reached my goal. In the words of Neville Goddard, “The feeling is the secret.”

Back to the client that I quoted in the beginning: Laura has lost over 25 pounds by implementing my simple tips and tweaks. But even better, she has a newfound confidence and zest for life. Approaching her sixties she is feeling better than she has in years, truly loving her body AND her life. And that’s what this is all about.

This article was provided as part of our Success Stories series from Elizabeth, a long-time member of the Mark’s Daily Apple community. Elizabeth originally shared her story with us six years ago, and while we were impressed then, we’re blown away now. Congratulations, Elizabeth, and happy birthday! Your success is well deserved. We hope you find her story, and her positive attitude, as inspiring as we do.  If you have your own success story and would like to share it, please reach out to us here.

If you’d like to add an avatar to all of your comments click here!

An international study led by Monash University has done what could be the world’s first demonstration of an AI model that can predict the optimal anti-seizure medication for newly diagnosed epilepsy patients.

WHAT IT’S ABOUT

The research team has trained a deep-learning prediction model using clinical information from around 1,800 patients in five health care centres in Australia, Malaysia, China and the United Kingdom. The model is designed by the Monash Medical AI Group and is trained using Monash’s MASSIVE computing facility.

Findings from the study, which was published in the journal JAMA Neurology, showed that the AI model has a “modest” 65% accuracy in predicting the best anti-seizure medication.

The research team is still improving the model by employing more complex information. Later, the enhanced predictive model will be tested in a national, multi-site randomised controlled trial called PERSONAL (Personalised Selection of Medication for Newly Diagnosed Adult Epilepsy). According to Monash, the said trial, which has received a A$2.46 million ($1.7 million) grant from the Australian government’s National Health and Medical Research Council, is designed to predict responses to epilepsy treatment, not actual seizures.

WHY IT MATTERS

About 70 million people around the world have epilepsy. Until now, there has been a lot of guesswork and experimentation by doctors on which anti-seizure drugs their patients will respond to, said Patrick Kwan, professor and neurologist from the Monash Central Clinical School’s Department of Neuroscience, who is leading the international study. 

He added that this trial-and-error process could harm patients more than benefit them. Side effects may range from allergies to psychiatric problems, or in the case of women, birth defects in their babies.

Dr Zhibin Chen, neuroscientist and biostatistician from Monash, said their AI model “will open the gate for personalising the management of epilepsy”.

Currently, the predictive model is intended for adults with new-onset epilepsy who are about to begin their medication. Monash said the model will serve as a basis for future models for people with more established epilepsy.

THE LARGER TREND

Research in India has produced novel algorithms that can spot the source of epileptic seizures using a patient’s EEG data. Developed by researchers from the Indian Institute of Technology – Delhi, the head harmonics-based array processing algorithms can pinpoint coordinates of seizure within minutes. These algorithms have been validated in a study that was recently published in Nature Scientific Reports.

Wearable technology is the latest in epileptic seizure detection, such as Epitel’s REMI system, which consists of a wireless EEG sensor that is worn below the hairline and software for providers to review data and monitor seizures. Early this year, the US-based company scored $12.5 million in Series A funding to commercialise its product.

Cough syrup, aspirin, toilet paper…and hearing aids. That may be some consumers’ drugstore shopping list this fall, thanks to a new FDA rule making some hearing aids available without a prescription in pharmacies, electronics stores such as Best Buy and online.

Is that good news or bad news for the 38 million American adults estimated to have trouble hearing?

It depends on whom you ask. Some advocates for those with hearing loss lobbied for the rule change, which they hope will make hearing aids cheaper, more accessible and less stigmatized. Hearing aid manufacturers are cheering expanded opportunities to market and sell their products.

But audiologists, even those who generally support the idea of non-prescription hearing aids, worry that without an initial evaluation and ongoing care, people will buy the devices without understanding how to use or adjust them. In addition, they won’t know the cause of their hearing loss, which could be triggered by earwax, fluid in the ear or, in rare cases, a tumor requiring surgery.

At the Hearing Loss Association of America, a Maryland-based consumer advocacy group that provides education and support to people with hearing loss who embrace technological fixes (as opposed to those born Deaf and who use American Sign Language), executive director Barbara Kelley says over-the-counter hearing aids mean “a new pathway to care” for millions of people.

“Eighty percent of people who could benefit from a hearing aid don’t get one,” she says—due to some combination of stigma, denial, cost and lack of access. They may live in rural areas, far from an audiologist; they may lack medical insurance that would pay for ongoing hearing health care. “If this makes those devices affordable and accessible, normalizing them, we think it’s a good thing.”

The FDA rule creates a category of hearing aids, available for those over 18 with mild-to-moderate hearing loss, that can be sold—as early as mid-October—without a prescription, fitting adjustment or hearing test required.

“I would say it’s not good news,” says Cindy Simon, Au.D., whose practice, based in South Miami, includes many older patients. “I spend two hours dispensing a hearing aid, showing [patients] how to use it, having them come back weekly for four weeks to make adjustments.

“Can you imagine going into Walgreen’s, buying a hearing aid and expecting the girl at the counter to sit down and teach you how to use it?”

Sherrie Davis, Au.D., Associate Director of Audiology and the Dizziness & Balance Center at Penn Medicine in Philadelphia, notes that it’s difficult for an individual to assess whether their hearing loss is mild, moderate or severe; minus a test, there’s no chance to catch other causes of poor hearing—from mild conditions like allergies to more serious ones such as an acoustic neuroma, a benign tumor on the nerves leading from the inner ear to the brain.

Some audiologists fear that consumers could damage their hearing by setting the devices for too high a volume; they advocated for limits on the “gain output”—the difference between the unamplified sound a patient hears and that same sound heard with a hearing aid. The FDA did not include limits on gain, though—in response to some of the more than 1,000 public comments received on the rule—it did cap the maximum sound output of OTC hearing aids at 117 decibels (nearly the level of a jet plane during take-off).

“We don’t want people putting devices on their ears and causing more hearing loss,” says Tricia Ashby-Scabis, Au.D., senior director of audiology practices at the American Speech-Language-Hearing Association, which represents speech pathologists, audiologists and similar professionals.

For the makers of hearing aids, the FDA rule is cause to celebrate. Gary Rosenblum, president of the hearing-aid company Oticon and chair of the Hearing Industry of America, the manufacturers’ association, says making hearing aids available over-the-counter (OTC) will lower their cost and boost accessibility.

But even he cautions that “over-the-counter hearing aids aren’t necessarily a panacea” and urges that people who buy non-prescription aids should still see a hearing care professional and ask pointed questions about return policies and warranties.

Currently, hearing aids cost anywhere from several hundred to nearly $8000 per pair, depending on their technological sophistication and the package of “bundled services” that come with an audiologist’s care; those may include a free 30- or 45-day trial, weekly visits for adjustment and questions, and several years of follow-up care.

The current market includes a wide array of hearing-aid types—from tiny buds that tuck inside the ear canal to behind-the-ear models with a transparent wire; rechargeable and battery-operated; hearing aids that sync with a smart phone and have Bluetooth capability.

“It’s naïve to think people can just buy something, program it, put it on their ear and have it work for them” says Ashby-Scabis. “I think there needs to be some thought to how we’re going to provide follow-up. I’m not sure [over-the-counter] hearing aids are going to be as simple a fix as was desired.”

Ashby-Scabis and other audiologists worry that consumers will try an over-the-counter hearing aid, find it frustrating to use on their own and give up on the devices entirely. “We don’t want people to think, ‘Hearing aids don’t work,’” she says.

On a community-health level, hearing loss amounts to far more than missed conversation at the dinner table or exasperating phone calls with Grandpa. Untreated hearing loss can lead to isolation, depression, anxiety, a heightened incidence of dementia and increased risk of falling.

It’s possible, audiologists suggest, that having hearing aids more visible—right next to the revolving kiosk of over-the-counter reading glasses at your local pharmacy—will raise awareness about hearing health while also reducing negative stereotypes and shame about hearing loss.

That stigma is already changing, they say, because of the popularity of ear buds and Bluetooth devices; it’s become normal to see people of any age with bits of plastic in their ears.

At the least, say audiologists, the buzz about over-the-counter hearing aids will make hearing loss a less-taboo topic. “Patients say, ‘I hate my hearing aids, and I can’t live without them,’” Ashby-Scabis says. “I hope there’s more awareness of the impact hearing loss has on health. I hope we’ll see that change in the years moving forward.”

The data are stark: the typical American diet is shortening the lives of many Americans. Diet-related deaths outrank deaths from smoking, and about half of U.S. deaths from heart disease – nearly 900 deaths a day – are linked to poor diet. The pandemic highlighted the problem, with much worse outcomes for people with obesity and other diet-related diseases.

“We’re really in a nutrition crisis in this country.” says Dariush Mozaffarian, a cardiologist and dean of the Friedman School of Nutrition Science and Policy at Tufts University

Now, there’s growing momentum to tackle this problem. The Biden administration will hold the White House Conference on Hunger, Nutrition, and Health on September 28th, and will announce a new national strategy. This comes more than 50 years after a landmark White House conference which helped launch today’s major federal food assistance programs.

“The 1969 conference was transformative,” Mozaffarian says. The programs it ushered in, like the WIC program, have helped feed millions of low-income families.

But this hasn’t been enough to solve the dual problems of food insecurity and diet-related disease. Food policy leaders say it’s time to think anew and build on what we’ve learned. The U.S. can’t “fix” hunger by just feeding people cheap, high-calorie, processed foods – the food that’s so abundant in our food supply, they say. Instead, it’s got to find ways to nourish people with healthy, nutrient-dense foods.

“There’s a lot of enthusiasm and thinking about food more broadly and how we can fix this crisis,” Mozaffarian told NPR. He’s co-chair of an independent task force that includes doctors, chefs, food policy and business experts, as well as farming and health advocates, who are helping form the agenda at upcoming the White House conference.

In a new report, they’ve proposed a wide-ranging set of recommendations to end hunger, advance nutrition and improve health. Here are seven big ideas they’re excited about.

1. Treat food as medicine

There’s a growing movement to integrate food and nutrition into health care, by providing healthy meals and groceries to patients to help prevent or manage diet-related illness.The task force wants to see this kind of work expand.

“We should pay for food-based interventions that are effective,” Mozaffarian says.

For example, there’s mounting evidence that providing prescriptions for fruit and vegetables can spur people to eat better and manage weight and blood sugar. The idea is for health care systems or insurers to provide or pay for healthy groceries, combined with nutrition education, to help patients change their eating habits. It is being piloted around the country.

“Produce prescription programs help improve diet quality and food security,” says task force member Dr. Hilary Seligman, a food insecurity expert and professor of medicine at University of California, San Francisco, noting that they can help with diet-related diseases like high blood pressure and diabetes.

Another idea is to offer medically tailored meals aimed at helping people who are already sick reverse chronic disease. Currently the federal government is running pilot programs that let Medicaid or Medicare pay for the meals in several states.

2. Focus on quality of calories, not just quantity

The U.S. food supply is awash in cheap calories. And when you’re on a tight budget or relying on benefits like SNAP (food stamps), processed foods like chips and soda can set you back less than fresh produce. Of course, eating processed foods also contributes to cardiovascular disease, stroke, diabetes and other chronic illnesses, warns Nancy Brown, CEO of the American Heart Association.

Brown says federal food assistance programs have helped to address hunger. “However, many U.S. food policies and programs focus on improving access to sufficient quantities of food,” she says. Instead, it’s time to modernize these policies and focus on the quality of food, “so people have access to enough nutritious food.”

The task force wants to see food programs redesigned to nudge people towards healthier options. The report points to the GusNIP nutrition incentive program – which, in select communities – gives SNAP participants more money to buy fruit and vegetables. It’s a similar concept to the Double Bucks program which doubles the value of SNAP benefits when used to buy produce at farmers markets and other venues.

“It is important to scale up these efforts to ensure that everyone has access to healthy food options,” says task force member Angela Odoms-Young, a nutrition professor at Cornell University.

The task force recommends that Congress establish a nationwide produce incentive program for all SNAP participants. “These types of programs can help promote equity,” Odoms-Young says, noting that people of color disproportionately suffer from chronic illnesses.

3. Expand access to dietary and lifestyle counseling

The Affordable Care Act mandates that diet counseling be covered by insurers as a preventive care benefit for those at higher risk of chronic disease. The exact details of who is eligible for which services are left up to an advisory group of doctors and health care providers, as well as insurers, and many patients who would benefit may not have access to this service.

“The vast majority of Americans should be getting preventative behavioral lifestyle treatment,” Mozaffarian says. Too often, he says, doctors prescribe drugs for conditions before recommending or trying lifestyle changes. “Doctors go right to the drug,” he says. “I think that’s a big problem.”

The task force recommends that Congress expand Medicare and Medicaid coverage for medical nutrition therapy to people with high blood pressure, prediabetes, celiac disease, HIV/AIDS, cancer and other diet-related conditions. It also calls for expanded coverage of cooking classes and nutrition assistance, as well as coverage of the Diabetes Prevention Program, delivered by telehealth. This behavior-change program has been shown to be more effective than medicine in reducing the onset of Type 2 diabetes among people at high risk.

4. Support food entrepreneurs

People who start food businesses can help nourish their communities and create jobs. The task force calls on the federal government to pass policies that boost new healthy food enterprises, including providing new loans and grants to food and nutrition-related companies centered on health, equity, and sustainability. The idea is to focus especially on businesses owned by people of color and other marginalized groups.

“We don’t need more businesses creating diabetes and obesity,” says Tambra Raye Stevenson, who runs Wanda, a non-profit group that aims to build a pipeline and platform for a million Black women and girls to become local food leaders. “We need entrepreneurs that provide teaching kitchens, community gardens, healthy food retails, wellness studios, nutrition services, healthy consumer products, and urban agricultural centers,” she says.

She points to food entrepreneurs like Amanda Stephenson who opened a specialty food market in an underserved neighborhood in Washington, DC, Fresh Food Factory, and Mary Blackford of Market 7 who is planning a food hall that features Black-owned food and lifestyle businesses. “They are our food she-roes making a positive impact and providing healthy food access for our children and other women,” says Stevenson.

In the lead up to next month’s White House conference, groups like Food Tank, a food think tank, have organized listening sessions with food researchers and entrepreneurs. “For food to be more accessible and affordable, we need entrepreneurs that use science and technology,” says Danielle Nierenberg of Food Tank. She points to innovators like Journey Foods which is helping entrepreneurs bring nutritious foods and snacks to market.

5. Increase the number of new farmers growing healthy foods using regenerative farming techniques

If all Americans began to eat the recommended amounts of fruits and vegetables each day, there would be shortages. That’s because corn and soybeans are grown on most cropland in the U.S.. Now, there’s growing recognition of the need for more specialty crops – including fruits, vegetables, and nuts.

The task force recommends that Congress create a Farmer Corps to support new farmers, building on the Beginning Farmers and Ranchers Development Program. The idea is to provide new farmers with paid internships and apprenticeships to learn about sustainable farming, and funding to cover a living wage and housing. It also is pushing for loans to go to farmers growing with sustainable practices.

Growing the same crop, season after season, as many farmers do, can make lands less productive over time, and deplete nutrients from the soil.”The unfortunate reality is that today we subsidize conventional practices that degrade the soil,”says David Montgomery, a professor at the University of Washington and the author of What Your Food Atewho attended a listening session.

“What we need to sustain agriculture is to incentivize restoring healthy soils and train more farmers to be successful doing that,” he says.

6. Make school meals free for all students

School meals have been a fixture in U.S. schools ever since President Harry Truman signed the National School Lunch Act back in 1946. For decades, the federal government has reimbursed schools for meals they serve, and low-income students can qualify for free or reduced priced meals. Research has shown that low-income children who participate have better health.

Yet, many families who are eligible for free or reduced-priced meals may not receive them, sometimes due to the paperwork, bureaucracy or stigma of participating or enrolling. Amid the pandemic, school meals have been offered for free to all students. Now, the task force says this should be a permanent change.

“Without access to free meals at school, many children go without food at all during the day, and many more do not have access to the nutritious foods they need to thrive,’ says Seligman, of UC, San Francisco. She notes that school meals help not only with kids’ nutrition, but they also reduce absenteeism and improve academic outcomes.

7. Establish a federal ‘food czar’

In order to turn ideas like these into action, the task force recommends the creation of a new role in the federal government, a national director of food and nutrition, a food czar figure, if you will. The new director would help streamline and coordinate the many disparate efforts already underway. The U.S. government spends more than $150 billion each year on food and nutrition related programs, and the health care system also spends billions on treatment of diet related diseases.

“This spending is fragmented across 200 separate actions and 21 different departments and agencies without harmonization or synergy,” the task force concludes. Now, they conclude, it’s time for a new approach.

Like other virtual health technologies, remote patient monitoring grew in the midst of the COVID-19 pandemic. 

One study published in JAMA Internal Medicine earlier this month found a steep incline in its use among traditional Medicare beneficiaries, increasing from 91 claims per 100,000 enrollees in February 2020 to 594 claims per 100,000 enrollees in September 2021.

Waqaas Al-Siddiq, CEO of remote patient monitoring firm Biotricity, said consumers are much more aware of the technology since the pandemic and now want to understand how that data is being used to guide their care.

“A couple of years ago, they were looking at devices for personal use and collecting data. Now they’re looking at devices and technologies that are accurate and integrate within their care programs,” he said during a panel discussion at the Connected Health Summit. “How does that information translate? How does that information get to their doctor? How does that doctor use that? A couple of years ago, that last piece was never really at the forefront of the consumers’ minds.”

There are plenty of examples of the “digital front door,” where patients initiate their own care or connect with the health system online, including something as simple as researching symptoms on Google, said Amar Kendale, president of rural-focused hybrid care provider Homeward. 

But some patient populations aren’t as tech savvy or may have other priorities. For instance, he said some older adults value relationships with a provider they already trust. 

“I think that this idea of a digital front door has gotten a little bit overloaded,” he said. “And the premise that a person can self-navigate themselves to the right place to get care, it does place a lot of burden on the consumer.”

Brock Winzeler, president of Freeus, Becklar workforce safety and Becklar connected wellness at health and security tech firm Becklar, said they had a difficult time getting devices into seniors’ homes and encouraging their use during the height of the pandemic. 

So the company decided to focus on engagement and communicating with subscribers as part of their remote patient monitoring program. 

“One of the things that we noticed is beyond just using the peripherals — providing weight, blood pressure, pulse oximetry, all those things — how are they feeling? How did they sleep last night? Did they eat today? These types of questions would help us to assess their overall wellbeing,” he said. 

Meanwhile, there also has to be a balance between using devices people already own, like a smartphone, and developing a new specialty device, said Dan McCaffrey, vice president of digital health and software at Omron Healthcare.

Not everyone has the most up-to-date smartphone, and the people with the greatest health needs may not be early adopters of new technology, McCaffrey noted.

“I always like to start with the clinical outcome and then back into the technology, as opposed to starting with the technology and trying to move into the clinic,” he said.