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Chronic Fatigue Syndrome: Can Psychotherapy And Exercise Help?

[Recently] in The New York Times, David Tuller [wrote] about a study published in The Lancet that shows that psychotherapy is an effective treatment for chronic fatigue syndrome. In his article ”Psychotherapy Eases Chronic Fatigue, Study Shows,” Tuller writes:

The new study, conducted at clinics in Britain and financed by that country’s government, is expected to lend ammunition to those who think the disease is primarily psychological or related to stress.

The authors note that the goal of cognitive behavioral therapy, the type of psychotherapy tested in the study, is to change the psychological factors “assumed to be responsible for perpetuation of the participant’s symptoms and disability.”

In the long-awaited study, patients who were randomly assigned to receive cognitive behavioral therapy or exercise therapy, in combination with specialized medical care, reported reduced fatigue levels and greater improvement in physical functioning than those receiving the medical care alone — or getting the medical care along with training in how to recognize the onset of fatigue and to adjust their activities accordingly.

Interesting. Generally I like to stay away from the “it’s all in your head” debates. I’ll let the commenters do the talking here.

*This blog post was originally published at Shrink Rap*

Deep Brain Stimulation: Experts Warn About Aggressive Marketing

A paper published in the February issue of Health Affairs – discussed at length in an article in the New York Times – contains the sort of blunt, plain-spoken language you seldom read in academic journals. The authors, who include some of the most prominent neuroscientists and ethicists in the world, warn that manufacturers are misusing the FDA’s humanitarian device exemption to promote deep brain stimulation as a “treatment” for obsessive compulsive disorder (OCD).

In fact, they make clear that deep brain stimulation is very much an experimental procedure. Research is still at an early stage, and the risks to patients are not well defined. When suffering is severe and no other treatment has provided relief, there is value in making available an intervention like deep brain stimulation. But misleading or biased information, no matter where it comes from, certainly undermines patients’ ability to calculate benefits and risks.

To enable deep brain stimulation, a surgeon must first implant electrodes in the brain and connect them to a pair of small electrical generators underneath the collarbone. Deep brain stimulation uses electricity to affect how brain signals are transmitted in particular areas of the brain. The image to the left, from the National Institute of Mental Health, shows how deep brain stimulation depends on the implantation of pulse generators below the collarbone and electrodes in the brain.

Specific concerns are raised by the article in Health Affairs (and in our own article on this topic last year in the Harvard Mental Health Letter). Read more »

*This blog post was originally published at Harvard Health Blog*

Stress In Life: Respond Differently And Live Longer?

“This job is killing me” is not a statement of jest. It is a desperate plea of outright sincerity.

Stress, anxiety, depression — all have been associated with an increased risk of cardiovascular disease and mortality. But can interventions to help people cope with stress positively affect longevity and decrease risk of dying? The results of a new study in the Archives of Internal Medicine would imply the answer is an encouraging “yes.”

Constructively dealing with stress is easier said than done, but it would seem logical that if we can reduce our psychological and social stressors we might live longer and delay the inevitable wear and tear on our vessels. This study proved that one such intervention, cognitive behavioral therapy (CBT) for patients who suffered a first heart attack, lowered the risk of fatal and nonfatal recurrent cardiovascular disease events by 41 percent over eight years. Nonfatal heart attacks were almost cut in half. Excitement may be dampened by the fact that all-cause mortality did not statistically differ between the intervention and control groups, but did trend towards an improvement in the eight years of follow up.

Definitely less suffering. Maybe less deaths.

The authors state that psychosocial stressors have been shown to account for an astounding 30 percent of the attributable risk of having a heart attack. Chronic stressors include low socioeconomic status, low social support, marital problems, and work distress. Emotional factors also correlated with cardiovascular disease include major depression, hostility, anger, and anxiety. Read more »

*This blog post was originally published at The Examining Room of Dr. Charles*

A Biofeedback Pen For Managing Stress

Miguel Bruns Alonso, a graduate student at Delft University of Technology in The Netherlands, has developed a pen that detects how much twitching and twirling it’s being put through.

People under stress tend to move and shake a pen more than someone who is calm. In order to try to get a therapeutic effect out of the pen, Bruns built in counter motion feedback that makes the pen a bit more difficult to move around. Though initial experiments have shown a marginal benefit, further studies and development may prove the benefit of the technology. From TU Delft:

Bruns, who studies industrial design, carried out various experiments during the course of his research, which showed that people tend to play with their pens in their hands when they are tense. It also seems that when they are encouraged to check these nervous movements, or make more gentle movements, it is possible to gain more control over a situation. “Sensors in a pen could provide an unobtrusive way of measuring stress levels. Giving users the right feedback could then help them deal with their stress in a constructive way,” says Bruns. Read more »

*This blog post was originally published at Medgadget*

PTSD Flashbacks Reduced By Playing Tetris

tetris Playing Tetris Cuts Flashbacks in PTSDFlashbacks are vivid, recurring, intrusive, and unwanted mental images of a past traumatic experience. They are a sine qua non of post-traumatic stress disorder (PTSD). Although drugs and cognitive behavioral interventions are available to treat PTSD, clinicians would prefer to utilize some sort of early intervention to prevent flashbacks from developing in the first place. 

Well, researchers at Oxford University appear to have found one. Remarkably, all it takes is playing Tetris. Yes, Tetris!

The team responsible for the discovery was led by Emily Holmes. The writeup appears in the November issue of PLoS ONE. Holmes and colleagues had reasoned that the human brain has a limited capacity to process memories, and that memory consolidation following a traumatic experience is typically complete within six hours after the event. Holmes’ team also knew that playing Tetris involved the same kind of mental processing as that involved with flashback formation. So they figured if they had people play Tetris during that six-hour window after the traumatic event, it might interfere with memory consolidation of the traumatic experience. That, in turn, would reduce or eliminate the flashbacks. The idea worked like a charm. Read more »

*This blog post was originally published at Pizaazz*

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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