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Is the new professionalism and ACP's new ethics really just about following guidelines?

The Charter ( Medical Professionalism in the New Millennium.A Physician's Charter) did not deal with just the important relationship of ...

Thursday, November 17, 2016

Set point theory of threshold of physical actiivity to maximize the "health span"

Dr. Lazarus and Harridge from King's college in London have suggested that by observing the trajectory of decline in physiological parameters in highly trained athletes we are observing the diminution  of function due solely to aging. In other words, there is no confounding issue of inactivity's effect of time related losses in function.

They talk about a "set point" for optimal exercise  and a threshold of physical activity that is needed  to age optimally and to thereby optimize the so called health span.Exercise above this hypothetical set point would increase a person's athletic performance but may not positively affect health.

This is reminiscent of Busse's 1969  concept of primary and secondary aging wherein such things as exercise ( I suppose the nebulous optimal amount) and eating right ( if we can ever figure out what that is exactly) would would minimize secondary aging  but primary aging would trudge along unimpeded.

Wednesday, November 16, 2016

Is Medicine increasingly less about physicians and patients and more about "Big Medicine"?

By "big medicine", I mean to refer collectively to the large organizations that form much of the medical landscape in the U.S. These organizations are: insurance companies,HMOs,Big Pharma (large pharmaceutical companies ) and corporate not - for -profit hospitals and now ACOs.For economy of key strokes let us call it Bigmed. (Of course, not for profit needs to be in air quotes,)

Increasingly Bigmed controls the practice of medicine. This is not breaking news. Dr.Roy M. Poses has been writing and speaking about this issue for years. In 2003 he published an article describing the results of interviews he had with a number of physicians who expressed this key idea. "Medicine had been taken over by large organizations which did not honor the core values of physicians."

Poses has been prolific and tireless in efforts to address these (and other) threats to health care's core values and many of his commentaries can be read on the blog "Health care Renewal"

Now there are some other physicians joining the discussion.Dr. S. Supri and K. Malone have published an important commentary in the American Journal of Medicine in part striking similar themes to Dr. Poses.

Remember when the economist Alain Enthoven  rallied against the power of individual physicians , comparing the situation to that of herding cats , animals notoriously resistance to herding.Well, now the hospitals and clinics and other health care facilities are swarming with herds of  docile  trained cats who have not only leaned to dutifully bend over computers and enter required "quality" data  but also have  leaned helplessness

Sunday, November 13, 2016

More evidence of brain damage in NFL players

More evidence of   the brain damage that occurs  in  professional football players   was presented at the 2016 meeting of the American Academy of Neurology.See here.

Abnormalities in diffusion tensor imaging (DTI) and standard MR were found in a number of former NFL players . DTI reflects abnormalities in water molecule movement in white matter tracts. Dr. Francis Conidi studied 40 retired players 17 of which had positive findings on DTI .The average time in the league was 7 years and the average number of reported concussion was 8. Most of the players with findings were lineman. Linemen are less likely to sustain the very hard impacts that cause concussions and broken necks  but just watch  line play in a game for a few minutes and you can easily see the number of sub concussive head impacts that routinely  occur.

addendum: 12/27/16 On a recent Sunday night football ( or was it Monday or Thursday) I noticed the pre game comments by the announcer pointing out that 3 of one team's starting lineup would not play because they were on the concussion "protocol". Several years ago those players would likely be in the lineup. The point being concussions are very common and a short while ago no one cared.

Friday, November 04, 2016

What works best-HIIT,SIT or MICT for various aspects of the training effect?

HIIT is high intensity interval  training or interval training in which the person exercises to at least 80% of his maximal heart rate and often to 80-90% SIT is sprint interval training in which one goes all out exercising to the maximal possible.MICT ( moderate intensity continuous training) is the traditional aerobic exercise training in which the person does not get much over 50-60% of his maximal oxygen uptake.

There is not much  really new to HIIT or SIT other than the names. Roger Bannister did not invent the technique but he certainly used it in the preparation for his race ( 1954)  that broke the four minute mile. He would run ten quarter mile intervals in 59 seconds each jogging in between each. Today his training might be characterized at high intensity , low volume.

An excellent review on these 3 types of training and the important effect of exercise intensity is found in  a review by Maclnnis and Gibala (1) Gibala is Chair of the Department  of Kinesiology at McMaster University and has written extensively about high intensity interval training.

 The authors review aspects of the three training modes on mitochondrial proliferation,increases in capillary density and increases in V02 max. And the winners are for two of the three are SIT and HIIT.Only  in regard to increases in capillary density brought about by training does MICT hold an advantage but even that is in dispute as some studies show HIIT is just as good.

 In regard to all three it seems that the data strongly suggest that the key variable is intensity not duration nor frequency of training.See here for a 2016 lecture by Gibala outlining the case of interval training and the argument that intensity is the key variable.

Interval training is no longer just inside baseball type talk among athletes and coaches but has becoming mainstream in the world of rehabilitation , for example in cardiac ( see here) and pulmonary patients( see here), type 2 diabetes (see here)and heart failure patients.

(1) Maclnnis MJ and Gibala,MJ Physiological adaptations to interval training and the role of exercise intensity.J. of Physiology 2016,October 17