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Behavior Vs. Disease: A New Way To Look At Health

What is the leading cause of death in the United States? Heart disease? Cancer? No, it’s smoking. Smoking? Yes, depending on how you ask the question.

In the early 90s, McGinnis and Foege turned the age-old question of what people die of on its head by asking not what diseases people die of but rather what the causes of these are. Instead of chalking up the death of an older man to say lung cancer, they sought to understand the proximate cause of death, which in the case of lung cancer is largely smoking. Using published data, the researchers performed a simple but profound calculation — they multiplied the mortality rates of leading diseases by the cause-attributable fraction, that proportion of a disease that can be attributed to a particular cause (for example, in lung cancer 90 percent of deaths in men and 80 percent of deaths in women are attributable to smoking). Published in JAMA in 1993, their landmark study became a call to action for the public health community.

When looked at the conventional way, using data from the 2004 update of the original study, heart disease, cancer, and stroke are the leading causes of death, respectively. This accounting may help us understand the nation’s burden of illness, but does little to tell us how to prevent these diseases and improve health. Through the lens of McGinnis and Foege we get the actual causes of death (e.g., the major external modifiable factors that contribute to death). This analysis shows that the number one cause of death in America is tobacco use, followed closely by poor diet and lack of physical activity, and then alcohol consumption. Read more »

*This blog post was originally published at BeyondApples.Org*

Can Your Avatar Affect The Way You Live?

If you own a Nintendo Wii, have played World of Warcraft, or seen James Cameron’s cinematic spectacle, then you probably know what an avatar is. And because an avatar is simply a representation of yourself that you design, your avatar’s attributes could be as similar or different to you as you wish. [This editor's avatar is 6' 8", has six-pack abs, wears only fine European clothing, and has the voice of YouTube sensation Ted Williams.]

Do online avatars have any influence on their real-world counterparts? Researchers at the new Virtual Human Interaction Lab (VHIL) at Stanford University think so. According to VHIL, while avatars tend to be idealized versions of their users, evidence has suggested one’s virtual avatar does indeed influence a person.

In one experiment, a female student’s avatar was shown losing weight by running and gaining weight when standing still. As a result, it motivated this student to exercise more over a 24-hour period. In another experiment, watching a student’s avatar progressively age caused him to want to save money instead of spending it on partying.

With advances in technology continually making the world more and more connected with itself, avatars will continue to evolve also. According to Jeremy Bailenson, creator of VHIL, “avatars will soon play an even bigger role in our lives online. How we shape our own avatars and how we interact with others could have profound influences on our behavior.”

Article from the National Science Foundation: Virtual Self…

*This blog post was originally published at Medgadget*

Personal Genetic Testing: Psychological And Behavioral Effects

Genome-wide profiling is increasingly being marketed towards consumers to assess their risk of developing certain diseases. However, there has been little research into the psychological effects of these tests.

Researchers from Scripps Translational Science Institute have now looked into these effects in a large group of patients. They followed 2,037 participants who took the Navigenics Health Compass, a test that assesses the risk for about 20 common diseases, for a period of three months.

Taking the test did not increase anxiety symptoms, dietary fat intake, or exercise behavior. There was some test-related distress correlated with the average estimated lifetime risk of getting the diseases tested for, but at the same time 90.3 percent of all subjects had no test-related distress at all. The use of screening tests did not change among the group and notably health effects of the test were not studied.

In conclusion, personal genetic testing does not seem to generate a lot of distress, although the study was clearly limited by a high dropout percentage of 44 percent and the self-selection of participants who opted to do the test.

Article in New England Journal of Medicine: Effect of Direct-to-Consumer Genomewide Profiling to Assess Disease Risk

Flashback: An Interview with Navigenics…

*This blog post was originally published at Medgadget*

“Laxative Tantrums” In Kids?

This “Fletchers Castoria” ad from 1941 is priceless. And as someone who spends his days working with bound-up grumps like Mary, I was reassured to know that horrific constipation is not a me-generation problem born of chicken fingers and Goldfish. ”Laxative tantrums,” however, are new to me. I seem to have pretty good luck with Miralax and Kristalose in my office. Your mileage (or tantrums) may vary.

*This blog post was originally published at 33 Charts*

“Behavioral Medicine” To Prevent Skyrocketing Healthcare Costs?

Educating individuals about the costs of healthcare could save money and lead to a more efficient use of the healthcare system, report policy researchers at Tufts University School of Medicine and Boston University School of Public Health.

You mean that people, when faced with facts about cost (and their end of it), choose the less-costly option? When did this start? Oh, yeah — we do it all the time — except in medicine, where our costs will bankrupt the country.

*This blog post was originally published at GruntDoc*

Latest Interviews

IDEA Labs: Medical Students Take The Lead In Healthcare Innovation

It’s no secret that doctors are disappointed with the way that the U.S. healthcare system is evolving. Most feel helpless about improving their work conditions or solving technical problems in patient care. Fortunately one young medical student was undeterred by the mountain of disappointment carried by his senior clinician mentors…

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How To Be A Successful Patient: Young Doctors Offer Some Advice

I am proud to be a part of the American Resident Project an initiative that promotes the writing of medical students residents and new physicians as they explore ideas for transforming American health care delivery. I recently had the opportunity to interview three of the writing fellows about how to…

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Latest Book Reviews

Book Review: Is Empathy Learned By Faking It Till It’s Real?

I m often asked to do book reviews on my blog and I rarely agree to them. This is because it takes me a long time to read a book and then if I don t enjoy it I figure the author would rather me remain silent than publish my…

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The Spirit Of The Place: Samuel Shem’s New Book May Depress You

When I was in medical school I read Samuel Shem s House Of God as a right of passage. At the time I found it to be a cynical yet eerily accurate portrayal of the underbelly of academic medicine. I gained comfort from its gallows humor and it made me…

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Eat To Save Your Life: Another Half-True Diet Book

I am hesitant to review diet books because they are so often a tangled mess of fact and fiction. Teasing out their truth from falsehood is about as exhausting as delousing a long-haired elementary school student. However after being approached by the authors’ PR agency with the promise of a…

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