By Tara Parker-Pope for the NY Times

February 27, 2012

By the time 64-year-old Laura Milson decided to undergo total knee replacement after 12 years of suffering from arthritis, even a short walk to the office printer was a struggle.

After her surgery last August at the Rothman Institute at Thomas Jefferson University in Philadelphia, Ms. Milson spent a week in rehabilitation and says she hasn’t stopped walking since. “My son says to me, ‘You have to slow down,’ and I say, ‘No, I have to catch up!,’ ” she said. “It’s a whole different life.”

For Ms. Milson, who lives in Shrewsbury, Pa., replacing the joint in her right knee came with a surprising bonus: a 20-pound weight loss in two months. “I joked with my doctor, ‘I think you put a diet chip in my knee,’ ” she said. “The weight just sort of came off.”

Now she has joined Weight Watchers to drop a few extra pounds and is training for a three-day breast cancer walk in October.

For years surgeons have boasted of the pain relief and improved quality of life that often follow knee replacement. But now new research suggests that for some patients, knee replacement surgery can actually save their lives.
In a sweeping study of Medicare records, researchers from Philadelphia and Menlo Park, Calif., examined the effects of joint replacement among nearly 135,000 patients with new diagnoses of osteoarthritis of the knee from 1997 to 2009. About 54,000 opted for knee replacement; 81,000 did not.

Three years after diagnosis, the knee replacement patients had an 11 percent lower risk of heart failure. And after seven years, their risk of dying for any reason was 50 percent lower.

The study, presented this month at the annual meeting of the American Academy of Orthopedic Surgeons, was financed with a grant from a knee replacement manufacturer. It was not randomized, so it may be that these patients were healthier and more active to start with.

Still, the researchers did try to control for differences in age and overall health. And the findings are consistent with large studies of knee replacement and mortality in Scandinavia. Given the big numbers in the study and the size of the effect, the data strongly suggest that knee replacement may lead to improvements in health and longevity.

The theory behind knee replacement, said the study’s lead author, Scott Lovald, senior associate at Exponent, a scientific consulting firm in Menlo Park, is that it improves quality of life. “At the end of the day, we’re trying to figure out if quantity of life increases as well,” he added, noting that the team was conducting a similar review of Medicare data on the long-term benefits of hip replacement surgery.

The founder of the Rothman Institute, Dr. Richard H. Rothman, who has performed 25,000 joint replacement surgeries in his career, urged caution in interpreting data that are not randomized and controlled. Not every patient with knee arthritis is a candidate for joint replacement surgery, he said.

“People can tolerate a lot of knee disability for reasons we don’t totally understand,” he went on, adding, “If the pain is acceptable, you live with it; if it’s not acceptable, we’ll operate on you.”

Dr. Rothman said that whether patients experience better health after surgery depends on motivation — how motivated they were to stay fit before surgery and how motivated they are now to become more active.

“For the motivated patient, it allows them to walk through that portal and become better conditioned and lose weight,” he said. “It’s not a weight-reduction program. It’s a potential avenue to improve your level of fitness, weight, cardiovascular health and mental health.”

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Provided by David Espo of MSNBC.com

Published on February 24, 2012

Four days before critical primary elections, Republican presidential contender Mitt Romney outlined a far-reaching plan Friday to gradually delay Americans' eligibility for Medicare as well as Social Security.

Romney said the shift, as people live longer, is needed to steer the giant benefit programs toward economic sustainability.

Speaking to the Detroit Economic Club - in cavernous Ford Field, where the Detroit Lions football team plays - he also made a play for primary election support in Michigan, which votes on Tuesday along with Arizona.

Romney said previous steps to toughen government emission standards had "provided a benefit to some of the foreign automakers" at the expense of American companies. He said future changes should be worked out cooperatively between government and industry.

Campaigning in the city where he was born, Romney described himself as "a car guy" who has a Ford Mustang and a Chevy pickup and whose wife, Ann, drives "a couple of Cadillacs." Aides said they were model year 2007 and 2010 SRX vehicles, one each registered in Massachusetts and California.

Romney said his proposals for Medicare and Social Security would begin in 2022, meaning no current or near-retirees would be affected. He also said he favors adjustments to curtail the growth of future benefits for the relatively well-to-do, so "lower-income seniors would receive the most generous benefits." He had described his Social Security proposals previously.

The two programs provide retirement and health care benefits to tens of millions of older Americans.

Beginning in 2022, Romney said, "we will gradually increase the Medicare eligibility age by one month each year. In the long run, the eligibility ages for both programs will be indexed to longevity so that they increase only as fast as life expectancy."

Under current law, the age for collecting full Social Security benefits is gradually rising from 65 to 67. Medicare is available at age 65. In both cases, the age is set in law, and Romney's suggestion that it be tied automatically to increases in the life expectancy of Americans would mark a major change.

He spoke in the run-up to a pair of primaries that mark his latest tests as he tries to break free of Rick Santorum and his other persistent but underfunded rivals in the presidential race.

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By Anahad O'Connor for the NY Times

February 22, 2012

Sudden chest pain is the hallmark symptom of a heart attack. But a large new study shows that many people who are taken to hospitals for heart attacks never have chest pain and, as a result, are less likely to be treated aggressively.

The consequences may be especially deadly for younger and middle-aged women. In a new study of 1.1 million people, a surprising 42 percent of women admitted to hospitals for heart attack never had chest pain. By comparison, just 30.7 percent of men who were admitted didn’t experience chest pain. Women were also more likely to die after a heart attack; the mortality rate for women in the study was nearly 15 percent, compared with 10 percent for men.

“We think part of the reason is that women who are presenting with a heart attack might not have that classical presentation,” said Dr. John G. Canto, director of the chest pain center at Lakeland Regional Medical Center in Florida and an author of the study, which was published in The Journal of the American Medical Association. “So they may not be recognized as having a heart attack, and possibly some of these patients may present too late to receive lifesaving procedures.”

Heart disease is the leading cause of death among men and women, not just in the United States but around the world, killing about seven million people a year. Until the 1980s, heart disease was largely considered a male problem, and many studies that focused only on men drew a narrow picture of the typical signs of heart attack: chest pain, shortness of breath and radiating pain in the neck, back, jaw and arms. But more inclusive research since then has shown that while female heart patients may exhibit these symptoms, they are also more likely to show symptoms that are less typically associated with heart attacks, like sleep disturbances and severe unexplained fatigue in the days and weeks prior, as well as cold sweats, weakness and dizziness during the attack.

In their new study, Dr. Canto and his colleagues used data from a national registry of people admitted to hospitals for heart attack from 1994 to 2006 to look at differences in symptoms and mortality rates among men and women. The analysis, covering 1,143,513 people, showed that chest pain is in fact the most frequent symptom of a heart attack in both men and women. But a sizable minority of patients, about 35 percent over all, never had chest pain.

Women under 55 who had heart attacks but no chest discomfort had two to three times the risk of dying in the hospital compared with men of the same age with classic heart attack symptoms. But “the difference markedly declined and nearly disappeared with increasing age,” said Dr. Canto, who is also the director of cardiovascular prevention research and education at the Watson Clinic in Lakeland.

No one knows precisely why heart attack symptoms differ between men and women, but Dr. Canto speculated that many factors may be involved, including hormones. Many women who take birth control pills, for example, tend to have “stickier” blood vessels and arteries than men, he said.

“We also know that in women, especially young women who have heart attacks, the mechanism of blood clot formation in the heart artery may be different than in young men,” he said. “They tend to involve more plaque erosion and sloughing off rather than the plaque rupturing, which is the classic way that heart attacks occur.”

Those who are having a heart attack but do not feel tightness or pain in the chest may not realize what is happening, Dr. Canto said, and when they do show up for treatment, doctors may not immediately consider the possibility of a heart attack, particularly in women. As a result, the odds of immediately undergoing bypass surgery, heart catheterizations and other lifesaving procedures are decreased.

The reality is that many doctors tend not to think that younger women have heart attacks, said Dr. Mario Garcia, a member of the American Heart Association and chief of cardiology at the Montefiore Einstein Center for Heart and Vascular Care in New York. But it’s also known from other studies that even women who do experience classic symptoms of a heart attack, including chest pain, are less likely to seek medical attention than men.

“Men are quick to rush to see a physician,” said Dr. Garcia, who was not involved in the study. “Women worry more about their husbands than themselves.”

By Joseph Berger of the New York Times

Published on February 23, 2012

Faced with soaring health care costs and shrinking Medicare and Medicaid financing, nursing home operators are closing some facilities and embracing an emerging model of care that allows many elderly patients to remain in their homes and still receive the medical and social services available in institutions.

The rapid expansion of this new type of care comes at a time when health care experts argue that for many aged patients, the nursing home model is no longer financially viable or medically justified.

In the newer model, a team of doctors, social workers, physical and occupational therapists and other specialists provides managed care for individual patients at home, at adult day-care centers and in visits to specialists. Studies suggest that it can be less expensive than traditional nursing homes while providing better medical outcomes.

The number of such programs has expanded rapidly, growing from 42 programs in 22 states in 2007 to 84 in 29 states today. In New York City, a program run by a division of CenterLight Health System, formerly known as the Beth Abraham Family of Health Services, has over 2,500 participants at 12 sites in the metropolitan area.

“It used to be that if you needed some kind of long-term care, the only way you could get that service was in a nursing home, with 24-hour nursing care,” said Jason A. Helgerson, the Medicaid director for New York State. “That meant we were institutionalizing service for people, many of whom didn’t need 24-hour nursing care. If a person can get a service like home health care or Meals on Wheels, they can stay in an apartment and thrive in that environment, and it’s a lower cost to taxpayers.”

The recent influx of adult day-care centers and other managed care plans for the frail elderly is being driven by financial constraints as President Obama and Congressional leaders seek hundreds of billions of dollars in savings in Medicare and Medicaid. Nursing homes, which tend to rely heavily on Medicare and Medicaid dollars, are facing enormous financial pressure — Mr. Obama’s proposed budget includes a $56 billion Medicare cut over 10 years achieved by restricting payments to nursing homes and other long-term care providers.

Nationally, the number of nursing homes has declined by nearly 350 in the past six years, according to the American Health Care Association. In New York, the number of nursing homes declined to 634 this January from 649 in October 2007, and the number of beds to 116,514 from 119,691.

Over the next three years, New York State plans to shift 70,000 to 80,000 people who need more than 120 days of Medicaid-reimbursed long-term care services and are not in nursing homes into managed care models, Mr. Helgerson said.

The move away from nursing homes was highlighted on Thursday when Cardinal Timothy M. Dolan announced that the Archdiocese of New York, one of the state’s largest providers of nursing home care, is selling two of its seven nursing homes and opening or planning to open seven new adult day-care centers over the next three years.

“Seniors and others who have chronic health needs should not have to give up their homes and independence just to get the medical care and other attention they need to live safely and comfortably,” Cardinal Dolan said in a statement before he opened a 250-patient program at Saint Vincent de Paul Catholic Healthcare Center in the South Bronx.

These new adult day-care centers, known around the nation by the acronym PACE — Program of All-Inclusive Care for the Elderly — provide almost all the services a nursing home might, including periodic examinations by doctors and nurses, daytime social activities like sing-alongs and lectures, physical and occupational therapy and two or three daily meals. All the participants are considered eligible for nursing homes because they cannot perform two or more essential activities on their own like bathing, dressing and going to the toilet. But they get to sleep in their own beds at night, often with a home health care aide or relative nearby.

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By Gretchen Reynolds for the NY Times

Published January 18, 2012

Alzheimer’s disease, with its inexorable loss of memory and self, understandably alarms most of us. This is especially so since, at the moment, there are no cures for the condition and few promising drug treatments. But a cautiously encouraging new study from The Archives of Neurology suggests that for some people, a daily walk or jog could alter the risk of developing Alzheimer’s or change the course of the disease if it begins.

For the experiment, researchers at Washington University in St. Louis recruited 201 adults, ages 45 to 88, who were part of a continuing study at the university’s Knight Alzheimer’s Disease Research Center. Some of the participants had a family history of Alzheimer’s, but none, as the study began, showed clinical symptoms of the disease. They performed well on tests of memory and thinking. “They were, as far as we could determine, cognitively normal,” says Denise Head, an associate professor of psychology at Washington University who led the study.

The volunteers had not had their brains scanned, however, so the Washington University scientists began their experiment by using positron emission tomography, an advanced scanning technique, to look inside the volunteers’ brains for signs of amyloid plaques, the deposits that are a hallmark of Alzheimer’s. People with a lot of plaque tend to have more memory loss, though the relation is complex.

Next they genetically typed their volunteers for APOE, a gene involved in cholesterol metabolism. Everyone carries the APOE gene, but scientists have determined that those who have a particular variation of the gene known as e4 are at 15 times the risk of developing Alzheimer’s compared with those who do not carry the variant. The report also noted that carriers tend to show symptoms of dementia at a younger age, beginning in their late 60s, on average, instead of in their early 80s for people without the variant.

Fifty-six of the volunteers, of various ages and both sexes, turned out to be positive for APOE-e4. (A family history of Alzheimer’s may suggest that someone is a carrier for the e4 variant, Dr. Head says, but it also may not; there are probably many other, still-unknown genetic causes of the disease, she says.)

Finally, the scientists asked the volunteers to fill out detailed questionnaires about their exercise habits during the past 10 years. Recently, many studies have looked at whether being active can lessen someone’s risk for Alzheimer’s, but the results have been inconsistent, with some studies, in both animals and people, suggesting that regular exercise has a protective effect and others finding little discernible benefit.

One reason for the inconsistency, Dr. Head suspected, might be that many earlier studies did not differentiate between people with the e4 variant and those without, and each group, at least potentially, could respond differently to exercise.

And that certainly proved to be the case in this study. For the group as a whole, exercise provided marginal benefits. The volunteers who reported walking or jogging often — meeting (or, in rare instances, exceeding) the American Heart Association’s exercise recommendation of 30 minutes of moderate or vigorous activity five times a week — had fewer amyloid plaques than the volunteers who reported almost never exercising. But the preventive value of the exercise was small, barely reaching the level of statistical significance.

That situation changed, however, when the scientists examined the results for people with the e4 gene variant. Most of those who carried the APOE-e4 gene displayed much larger accumulations of amyloid plaques than those without it.

Unless they exercised. The carriers of the gene who reported walking or jogging for at least 30 minutes five times a week had plaque accumulation similar to that of volunteers who were e4-negative. In essence, the APOE-e4 gene carriers mitigated their inherited risk for developing Alzheimer’s by working out. Or, as the study authors wrote, a “physically active lifestyle may allow e4 carriers to experience brain amyloid levels equivalent to e4-negative individuals.”

“The good news is that we found that activity levels, which are potentially modifiable, could have an impact” on plaque accumulation — and presumably on the course of Alzheimer’s — in people with a genetic predisposition to the condition, Dr. Head says.

But the findings came with a downside, too. An overwhelming majority of the people in the study were sedentary, and for them, an inactive lifestyle seemed to be accelerating the accumulation of amyloid plaques. Those with the e4 variant who rarely or never exercised had the most plaques, putting them at heightened risk for the memory loss of Alzheimer’s in the years to come.

At the moment, it’s not known whether beginning to exercise after plaques have started to build up might alter that outcome, Dr. Head says. But, she continues, experiments in mice bred to develop memory loss “have shown that elderly animals that began a running program benefited.” They experienced less dementia than mice that didn’t run.

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By Laurie Tarken for the NY Times

Published February 20, 2012

The aging eye filters out blue light, affecting circadian rhythm and health in older adults.

THE INVESTIGATORS

Dr. Martin Mainster and Dr. Patricia Turner, University of Kansas School of Medicine.

For decades, scientists have looked for explanations as to why certain conditions occur with age, among them memory loss, slower reaction time, insomnia and even depression. They have scrupulously investigated such suspects as high cholesterol, obesity, heart disease and an inactive lifestyle.

Now a fascinating body of research supports a largely unrecognized culprit: the aging of the eye.

The gradual yellowing of the lens and the narrowing of the pupil that occur with age disturb the body’s circadian rhythm, contributing to a range of health problems, these studies suggest. As the eyes age, less and less sunlight gets through the lens to reach key cells in the retina that regulate the body’s circadian rhythm, its internal clock.

“We believe the effect is huge and that it’s just beginning to be recognized as a problem,” said Dr. Patricia Turner, an ophthalmologist in Leawood, Kan., who with her husband, Dr. Martin Mainster, a professor of ophthalmology at the University of Kansas Medical School, has written extensively about the effects of the aging eye on health.

Circadian rhythms are the cyclical hormonal and physiological processes that rally the body in the morning to tackle the day’s demands and slow it down at night, allowing the body to rest and repair. This internal clock relies on light to function properly, and studies have found that people whose circadian rhythms are out of sync, like shift workers, are at greater risk for a number of ailments, including insomnia, heart disease and cancer.

“Evolution has built this beautiful timekeeping mechanism, but the clock is not absolutely perfect and needs to be nudged every day,” said Dr. David Berson, whose lab at Brown University studies how the eye communicates with the brain.

So-called photoreceptive cells in the retina absorb sunlight and transmit messages to a part of the brain called the suprachiasmatic nucleus (S.C.N.), which governs the internal clock. The S.C.N. adjusts the body to the environment by initiating the release of the hormone melatonin in the evening and cortisol in the morning.

Melatonin is thought to have many health-promoting functions, and studies have shown that people with low melatonin secretion, a marker for a dysfunctional S.C.N., have a higher incidence of many illnesses, including cancer, diabetes and heart disease.

It was not until 2002 that the eye’s role in synchronizing the circadian rhythm became clear. It was always believed that the well-known rods and cones, which provide conscious vision, were the eye’s only photoreceptors. But Dr. Berson’s team discovered that cells in the inner retina, called retinal ganglion cells, also had photoreceptors and that these cells communicated more directly with the brain.

These vital cells, it turns out, are especially responsive to the blue part of the light spectrum. Among other implications, that discovery has raised questions about our exposure to energy-efficient light bulbs and electronic gadgets, which largely emit blue light.

But blue light also is the part of the spectrum filtered by the eye’s aging lens. In a study published in The British Journal of Ophthalmology, Dr. Mainster and Dr. Turner estimated that by age 45, the photoreceptors of the average adult receive just 50 percent of the light needed to fully stimulate the circadian system. By age 55, it dips to 37 percent, and by age 75, to a mere 17 percent.

“Anything that affects the intensity of light or the wavelength can have important consequences for the synchronization of the circadian rhythm, and that can have effects on all types of physiological processes,” Dr. Berson said.

Several studies, most in European countries, have shown that the effects are not just theoretical. One study, published in the journal Experimental Gerontology, compared how quickly exposure to bright light suppresses melatonin in women in their 20s versus in women in their 50s. The amount of blue light that significantly suppressed melatonin in the younger women had absolutely no effect on melatonin in the older women. “What that shows us is that the same amount of light that makes a young person sit up in the morning, feel awake, have better memory retention and be in a better mood has no effect on older people,” Dr. Turner said.

Another study, published in The Journal of Biological Rhythms, found that after exposure to blue light, younger subjects had increased alertness, decreased sleepiness and improved mood, whereas older subjects felt none of these effects.

Researchers in Sweden studied patients who had cataract surgery to remove their clouded lenses and implant clear intraocular lenses. They found that the incidence of insomnia and daytime sleepiness was significantly reduced. Another study found improved reaction time after cataract surgery.

“We believe that it will eventually be shown that cataract surgery results in higher levels of melatonin, and those people will be less likely to have health problems like cancer and heart disease,” Dr. Turner said.

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By Tara Parker-Pope for the NY Times

Originally printed January 17, 2008

As a health writer, I’ve read hundreds of nutrition studies and countless books on diet and eating. And none of these has contained such useful advice as the cover of Michael Pollan’s latest book, “In Defense of Food.”

Wrapped around a head of lettuce are seven words that tell you pretty much everything you need to know about healthful eating. “Eat food. Not too much. Mostly plants.”

Author Michael Pollan (Alia Malley)This seemingly-simple message is surprisingly complex, because there is food, and then there are what Mr. Pollan describes as “edible food-like substances.” Mr. Pollan, who writes for The New York Times Magazine, developed something of a cult following for his best-selling book “The Omnivore’s Dilemma,” which traced the food chain back to its original source. But while “Omnivore” left many scared to eat, “In Defense of Food” helps the reader bravely navigate the food landscape, explaining what food is, what it isn’t and how to tell the difference.

Mr. Pollan agreed to take some time this week to answer a few questions from the Well blog.
Q: In this book, you talk about “nutritionism,” the tendency of scientists and nutrition experts to view food as just a sum of its nutrient parts. What’s wrong with that thinking?

A: Two things go wrong with nutritionism. Whatever tentative scientific information is developed, it gets very quickly distorted by the food marketers and manufacturers. They will take partial information about antioxidants, and they are suddenly telling you if you eat almonds you are going to live forever. There is a distortion of what are hypotheses of science. We’re guilty of this too. We take sketchy science, and we write headlines.

One of the things that surprised me is how poor the data is that is underlying many of these big dietary trials. If you try to fill out a food frequency questionnaire, you realize very quickly this is not good data. I was as honest as I could be and tried to remember what I’d eaten, and it claimed I was only eating 1,200 calories a day. Clearly, I was forgetting at least 1,000 calories. We know people underreport by about 30 percent. We don’t know the first thing about nutrition, which is, “What are people actually eating?” It’s hard to build good science on top of that.

Q: Did you expect the phrase, “Eat food. Not too much. Mostly plants.” to create such a stir?

A: I was kind of surprised. After the original article in The Times magazine used those words, I started hearing it then. I realized they had a certain power. That’s why I encouraged the publisher to put them on the cover and give it all away there.

Q: But it’s not as simple as it sounds, is it?

A: It’s not, because of all these edible food-like substances in the stores that are masquerading as food. It’s simple advice as long as you know what food is, but I spend 14 pages trying to define what food is. It’s gotten complicated because of food science and the kind of engineering that’s gone into processing food.

Q: Speaking of engineering, food from cloned animals appears headed for approval in Europe and the United States. Does cloned food qualify as real food?

A: I think the bigger concern with cloned animals is not personal health. It’s what will it take to keep a herd of genetically identical chickens, horses or pigs alive? Sex and variation is what keeps us from getting wiped out by microbes. If everything is genetically identical, one disease can come along and wipe out the entire group. You will need so many antibiotics and so much sanitation to keep a herd of these creatures going. The bigger concern should be antibiotic resistance.

Q: The nutrition community is fascinated by the French paradox — the fact that the French eat seemingly fattening food but don’t get fat. In your book you describe an American paradox. What is it?

A: Americans are a people so obsessed with nutrition yet whose dietary health is so poor. That strikes me as a paradox. We worry more about nutritional health, and we see food in terms of health. Yet we’re the world champs in terms of obesity, diabetes, heart disease and the cancers linked to diet. I think it’s odd. It suggests that worrying about your dietary health is not necessarily good for your dietary health.

Q: So how should we think about food and health?

A: I think health should be a byproduct of eating well, for reasons that have nothing to do with health, such as cooking meals, eating together and eating real food. You’re going to be healthy, but that’s not the goal. The goal should just be eating well for pleasure, for community, and all the other reasons people eat. What I’m trying to do is to bring a man-from-Mars view to the American way of thinking about food. This is so second nature to us — food is either advancing your health or ruining your health. That’s a very limited way to think about food, and it’s a very limited way to think about health. The health of our bodies is tied to the health of the community and the health of the earth. Health is indivisible. That’s my covert message.

Q: A reader commented recently that this sounded like a diet book. Is it?

A: There is no Michael Pollan diet. It’s an algorithm to help you make decisions rather than telling you narrowly: “Eat butter. Don’t eat margarine.” Although you could probably deduce that from what I’m saying. I don’t feel like it’s our job to tell people what to eat. I think our job is to help people think about it. I’m trying to take down the cult of expert eating. The danger is that I then offer myself as an expert. I’m trying to channel the wisdom of culture about eating. My idea here is that science so far hasn’t figured out nutrition well enough to be the arbiter of our food choices. When science has done that — take the public health campaign around fat, that has been the biggest test case — it didn’t work out very well. If science can’t guide us yet, who can? The answer is not me. The answer is culture, history and tradition. That’s what my rules are all about. The book is trying to show why this nutritionism approach to food doesn’t work very well, besides the fact that it ruins our pleasure in eating.

Q: What do you eat?

A: I eat lots of food. What do you mean?

Q: Does your food ever come out of a package?

A: Really seldom. If you look in my pantry, you won’t find that much processed stuff. Maybe some canned soups and tuna fish. I don’t have a lot of low-fat products. I much prefer to eat less of a full-fat product. You wont’ find skim milk. We’re lucky. I live in Berkeley with a farmers’ market four blocks away, and it’s open 50 weeks a year. I have the luxury of being able to buy very fresh, good food. I have a weakness for bread. A good white baguette — I have a weakness for that.

Q: After reading your book, I want to plant and grow something. Do you get this a lot?

A: My first book was about gardening, and I like gardening. It’s a really important part of the solution. In so many places, including urban areas, there is a yard, there is a lawn, a little patch of land where you could grow food. My garden is only 10 by 20 feet. It’s a postage stamp. I grew so much food there last summer. What food is more local than the food you grow yourself, not to mention the fact that you get all this exercise while you’re gardening.

Q: How does one stop eating edible food-like substances and switch to eating real food? Isn’t it difficult to change?

A: We have more choices now than we’ve ever had. There is organic food at Wal-Mart. The big challenge is that you do have to cook. A lot of us are intimidated by cooking today. We watch cooking shows on TV but we cook very little. We’re turning cooking into a spectator sport. This process of outsourcing our food preparation to large corporations, which is what we’ve been doing the last 50 years, is a big part of our problem. We’re seduced by convenience. You’re going to have to put a little more time and effort into preparing your food. I’m trying to get across how pleasurable that can be. It needn’t be a chore. It can be incredibly rewarding to move food closer to the center of your life.

Published on February 21, 2012

By Judith Graham of Kaiser Health News

This story was produced in collaboration with Nortin Hadler, a professor of medicine and microbiology/immunology at the University of North Carolina at Chapel Hill, has been warning for years about the lack of evidence supporting many popular medical treatments and tests.

His work is controversial. In books such as "Stabbed in the Back: Confronting Back Pain in an Overtreated Society" and "Worried Sick: A Prescription for Health in an Overtreated America," Hadler argues for holding medical interventions to a high standard: Do they reduce mortality or substantially lessen the burden of illness? Do potential benefits significantly outweigh potential harms? Unless research proves this, the interventions should be avoided, Hadler insists.

In his newest book, "Rethinking Aging: Growing Old and Living Well in an Overtreated Society," the 69-year-old Hadler turns his attention to older Americans and the challenging medical decisions they face.

Q: You’ve called your book "Rethinking Aging." What do you want readers to understand about aging?

A: This book is a celebration of the fact that the baby boomers and the traditionalists — the generation that came before the boomers — are the first in the history of the world to hit age 60 and to be able to say, rationally, "What do I want to do with the next 25 years of my life?"

We shouldn’t worry so much about what will kill us; instead, we should be focusing on making it to age 85 and having a pleasing journey along the way.

Q: You’re concerned about the medicalization of aging. Explain why.

A: You can be healthy well beyond 60, but you’ll be different than you were when you were 20. You’ll have different posture, wrinkles and a lot of other changes that are less obvious but age appropriate. We have to be very, very careful about calling any difference from when we were younger an illness or a disease. And we have to be even more careful about telling people that we have things we can do to "fix" these differences, but this happens all the time. That's the medicalization of aging.

Q: What’s the alternative?

A: Helping people understand what’s normal for their age and how to accept and adjust to those normal changes.

Q: You talk a lot about the importance of older people making informed medical decisions.

A: For the first time in the history of medicine, we have a tremendous amount of information about efficacy: what makes sense to do medically and what doesn’t.

What I want to teach people is that it's perfectly appropriate for patients to ask their doctors, "How certain are you that what you are offering me will produce meaningful benefits? What does the evidence show about the possibility of harm?"

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By Jason Selss, Communication Director

February 17, 2012

“Heart disease is the leading cause of death in the United States, fortunately you can reduce your risk with cardiovascular screening and healthy lifestyle choices,” says Mitchell Strand, MD, chief medical officer of Touchstone Health HMO.

SCREENING

Discuss with your doctor ways to ensure early detection of heart disease. Every five years, Medicare covers cardiovascular testing that checks your cholesterol, blood fat (lipid), and triglyceridelevels. In addition, check your blood-pressure regularly. These tests determine your risk for a heart attack or stroke and provide invaluable information for healthy living.

The results of these tests will determine steps you can take if you are at risk such as medication or lifestyle change. Remember your ABCS  for a healthier heart:

            A– Appropriate aspirin therapy

            B– Blood pressure control

            C– Cholesterol management

            S– Smoking cessation

 EAT WELL and MOVE MORE

At immediate risk or not,simple lifestyle changes contribute to healthy senior living for you and your loved ones. Eating balanced meals with lean proteins, fruits and vegetables is good for your heart and overall well-being. Follow an eating plan that is low in both saturated and trans fats as well as cholesterol. Be aware of your sodium intake and the foods, such as bread, deli meats, pasta dishes and snacks, that contain a high sodium content.

Increase your activity level with walking, low impact aerobics or fun activities like dancing. Thirty minutes of exercise most days is ideal. Consult with your physician to create a wellness plan that is appropriate.

KNOWLEDGE

Join the Million Hearts initiative for support and information about heart health. This campaign is working to prevent 1 million heart attacks and strokes during the next five years and the website provides tools and resources about cardiovascular disease and stroke prevention.You can also follow the campaign on Twitter and Facebook.

 TAKE CONTROL

1 in 3 people in the United States have some form of heart disease, which can include severe chest pain, heart attacks, heart failure, and stroke, but, with regular screenings as part of Medicare preventive services, a healthy life style and knowledge, you can take control and improve your cardiovascular health. After all, the best Valentine heart for you and your loved ones is a healthy one.

 Medicare beneficiaries can visit Medicare.gov to download a copy of "Your Guide to Medicare Preventative Services" for more information about Medicare coverage for preventive services.

By Julie Rovner for NPR Health

Published February 16th, 2012

The good news for the nation's doctors — and the millions of Medicare patients they care for — is that assuming everything goes as planned, the 27.4 percent cut in reimbursements that would have taken effect March 1 won't.

The bad news? The fix included in the deal to extend the payroll tax holiday isn't permanent. It only extends to the end of the year.

And then, if Congress doesn't act again, the cut it is expected to be well in the neighborhood of 32 percent.

That's leaving doctors in a continuing state of uncertainty.

"Disgruntled is probably just too soft of a term for this," says Robert Wah, a reproductive endocrinologist at the National Institutes of Health and the Walter Reed Army Medical Center. He's also Chairman of the Board of Trustees of the American Medical Association. "It's really devastating to try to run an office in this environment."

Wah says doctors have been through this exercise before — waiting to see if Congress will stop a scheduled Medicare cut. Too many times.

"In 2010, Congress did this to us five times," he said. "There were five patches put in place, and a couple of times they actually waited until after the deadline," which meant payments were delayed.

Wah says many physicians are also small businesses. So the uncertainty of knowing how much — or in some cases whether they're going to be paid to see their Medicare patients, is more than just an inconvenience. "Because they have to continue to pay their rent and their insurance and their electric bill and the salaries of the people that work in their office," he says.

Until now, the public hasn't had a lot of sympathy for the plight of America's doctors and their Medicare woes. Despite their complaints, doctors still earn a lot more than the average American. And surveys showed that most doctors continued to treat Medicare patients.

This problem with how Medicare pays doctors is the result of a funding formula enacted in 1997 that's since gone awry. It affects many members of the military, too, because rates for the TRICARE health program are tied to those for Medicare.

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