Friday, December 15, 2006
"Eragon" author reveals the secret to his genius
"Eragon" author Christopher Paolini
Editor's note: Christopher Paolini is the 23 year-old author of the young-adult fantasy books "Eragon" and "Eldest." A film based on "Eragon" opens nationwide today. Paolini was featured in the Dr. Sanjay Gupta Special "Genius" earlier this year. We invited him to blog on planting and cultivating the seeds of genius.

When I met Sanjay Gupta this summer, we spent a long time talking about creativity: how to define it, the importance of encouraging it in childhood and early adulthood, its importance in nearly every aspect of modern life, and what people can do to develop creativity in themselves and in others.

The conversation reminded me of certain methods my parents used when home schooling my sister and me, techniques that helped us express ourselves freely and find unique solutions to problems. For example, whenever we became curious about a particular subject, my mother would surround us with information on that topic: books from our local library, pictures, music, sticker books... anything relevant to the subject. She would encourage us to draw pictures and write a few paragraphs on the subject, and then she would take these pages and bind them into booklets.

The rich environment my parents provided taught us to embrace new knowledge and to enjoy educating ourselves. These are habits that anyone can learn on their own. Whenever you come across an unfamiliar fact or skill, grab hold of it and learn everything possible about it. By doing so, you can acquire a vast pool of facts, figures, and abilities: the primordial soup from which creativity can arise. For creativity, at its simplest, is the art of putting together seemingly unrelated things and combining them in new ways. By doing that- by looking at the world from a different perspective - it's possible to achieve greater success in work, play and in artistic endeavors.
Less HRT may be the key to less breast cancer
It is nice to blog about some good news every once in a while. A new study shows that breast cancer rates plunged 7 percent overall and in some cases as much as 14 percent in 2003. That is especially good news considering there had been a steady increase in breast cancer from 1975 to 2000, with almost a 30 percent increase over that time. (Full Story)

Most interesting perhaps, is that many researchers believe they know exactly why the rate is going down.

They point to the swirling negative problems surrounding hormone replacement therapy or HRT. In July 2002, the Women's Health Initiative warned that HRT could actually lead to an increase in breast cancer and heart disease. It seems patients and their doctors started to pay attention. By the end of 2003, the number of prescriptions written for HRT went from around 22 million to 12 million. Shortly thereafter, we started to see the first declines in breast cancer. At first, it was just small changes but now for women with estrogen-fueled tumors, the most common breast cancer rates have dropped up to 14 percent. For all age groups, the rate dropped 7 percent.

Not surprisingly, representatives from the American Cancer Society are being cautious. After all, it is just one year's worth of data and that hardly makes a trend. Still, that hasn't dampened the enthusiasm of breast cancer researchers who have been working their entire lives for a win.

What is most difficult, though, are the conversations I have had with many women around the country about HRT. So many of these women are simply debilitated and unable to function because of the frustrating symptoms of menopause. They will read today's news and still refuse to give up their HRT, even though they know it could dramatically reduce their risk of breast cancer. To them, the risk is worth it. So, what should doctors tell these women and is there anything else out there that works?
Thursday, December 14, 2006
Senator's speech signals bleeding brain
Yesterday, Sen. Tim Johnson, a South Dakota Democrat, was in a meeting when he suddenly started having difficulty speaking. At first, he couldn't find the right word, then he started stammering and finally stopped speaking altogether. After he walked back to his office, it seemed that his right arm or leg had become numb. His staffers didn't know what was wrong at first, but then sent him to the hospital. It was the right thing to do. Johnson was having symptoms that sounded like a stroke.

As we now know, the senator actually had a congenital arterial venous malformation in his brain, known as an AVM. This is a cluster of arteries and veins in the brain that grow together. Sometimes, for unclear reasons, this tangle of blood vessels will bleed - and that blood puts pressure on the brain. The pressure causes the stroke-like symptoms. He underwent an operation to remove the blood and stabilize the tangle. The doctors say it was successful, and the senator is now recovering. Judging from the location of his bleeding, his recovery will most likely take quite a while. It was on the left side of his brain, in an area responsible for the ability to speak and understand. Most surprising to many is that this AVM was probably with the senator his entire life and never before caused any problems. The senator probably never even knew he had a problem until he could no longer speak.

Most people reading this and watching the news coverage are immediately wondering whether this could happen to them. The answer is: It's very unlikely. You have about a 1/1000 chance of having such a problem. Still, many people may want to get screened to tell them for sure. They never want to be in the position in which the senator now finds himself. The problem is that the screening can get very expensive. The best test to look for this sort of problem can cost $2,000. If everyone in the nation were screened, the cost could be in the hundreds of billions of dollars. Is it worth it? Let's hear your thoughts.
Wednesday, December 13, 2006
Anti-Depressants and Suicide Risk
One story that has fascinated me the most over the last couple of years is the one about anti-depressants and suicide risk. You may remember that in October 2004, a black box warning label was created for antidepressants used to treat children. This warning, which is located prominently on the package insert, warns specifically of an increase in suicidal thoughts if someone is taking the medication. It was fascinating to me, because it seemed so counterintuitive - I mean, weren't anti-depressants supposed to make someone feel better? And, didn't it make more sense that the depression itself was leading to the suicidal thoughts or behaviors?

Well, that is at the heart of what promises to be a very contentious FDA hearing today. Studies have shown that using antidepressants elevates the risk of suicidal thoughts and behaviors in young adults. So a similar black box warning for antidepressants being used by adults is being considered. There will be testimony from individuals whose loved ones committed suicide while on the medications. And, there will be testimony from the American Psychiatric Association telling the FDA that the risk of increased suicidal thoughts is small and greatly outweighed by the risk of untreated depression.

It is unclear as to why the use of antidepressants and suicide would be linked. It could be that an alteration in the brain chemistry affects some people differently, actually causing a downward spiral, instead of a mood enhancement. Or, it could be that antidepressants elevate someone's energy levels before their mood. So, they have just enough energy to start acting out suicidal thoughts, while they are still depressed. It might just be the natural and sometimes tragic natural history of depression.

It is clear that depression remains a widely stigmatized disease and that too many people don't get the treatment they need. After the black box warnings were implemented in 2004, prescriptions for anti-depressants went down 20% for young adults, potentially leading to even more untreated depression in that group of people. There is a possibility that could happen again, if those warning are extended to adults. So, if you had a chance to weigh in on these FDA hearings, what would you say?
Tuesday, December 12, 2006
Resident Work Hour Limitations a Bad Thing??
Over the past few months, we have been working on a documentary about the impact of resident work hours. There have been many studies about this topic, primarily relying on questionnaires, but we decided to spend several weeks with resident doctors from different specialties to see for ourselves what their work hours and their lives were really like. Several things started to become apparent.

First off, it is true that resident doctors do routinely work shifts lasting longer than 24 hours. In fact, despite regulations put in place by the Accreditation Council for Graduate Medical Education, many surgical residents work 30-hour shifts twice a week on top of their regular daily hours, for a total of 80 to 88 hours a week. While the limit is 80 hours, an extra eight hours may be added, if used specifically for learning purposes.

It also became clear that anybody who is awake for 24 hours in a row has trouble staying awake and may nod off from time to time, usually in lectures or when in front of the computer finishing paperwork.

Finally, as we interviewed people from various facets of medical education, such as deans, chairmen of training programs, residents themselves and nurses, we realized that the regulation of work hours is a very contentious issue.

At heart is the obvious, which is the possibility that sleepy doctors might make more mistakes. And, according to a study released yesterday from the division of sleep medicine at Brigham and Women's Hospital, doctors in training reported that they were four times more likely to make a fatigue-related medical error after working five or more long shifts. Others will argue that resident doctors need to work the longer shifts so they can have continuity of care with sick patients. After all, if they leave the hospital in the middle of caring for a patient, couldn't that jeopardize care? And, what about the concern that doctors who have curtailed the number of hours in a residency program might not be trained as well for real-life practice as doctors who worked the longer shifts?

It is by no means an easy question. For now, the work hours will be regulated. I am eager, though, to hear what you think.

Look for CNN Presents: Grady's Anatomy coming to CNN in March.
Monday, December 11, 2006
The Menopause Catch-22
Menopause isn't a disease.

But for the 150,000 American women entering menopause each month, the mood swings, hot flashes and libido changes that often accompany a drop in estrogen can leave them feeling, "I need help."

Consider: 50 percent of all women go to their doctor for menopausal symptoms. But many women have mixed feelings about taking medications for this natural change of life. Do benefits outweigh risks?

The FDA has revised its guidelines, stating that hormone therapy should be used only for the short-term relief of symptoms - and only for low-risk patients (no smokers, no history of breast cancer) because of the risk of breast cancer, heart attacks and stroke.

Yet, the American College of Obstetricians and Gynecologists maintains hormone therapy is effective at relieving menopausal symptoms, and may even ward off osteoporosis and memory loss.

Dr. Louann Brizendine runs the Women's Mood and Hormone Clinic at the University of California, San Francisco, and is author of the book, "The Female Brain." A neuropsychiatrist, she frequently prescribes not only hormone therapy, but anti-depressants such as Paxil, Prozac and Celexa in small doses to ease irritability and restore libido during a patient's seismic shift in her hormonal self.

"There are all sorts of things we doctors can use nowadays that can get you back to feeling your best," says Brizendine, stressing women may not need medication forever but rather just during the transitional period when they feel most on edge.

But what of this notion, 'this is what nature intended' and if we're out of control, we're bad? Dr. Brizendine, the daughter of protestant missionaries, has a ready anecdote.

While treating Sisters of Charity nuns for their menopausal symptoms a decade ago, she asked them whether their Lord would think it's a sin to take medication.

"Oh no," the nuns assured her. "He'd be upset if we didn't use everything provided by Him to help us be our best selves."

The decision to medicate menopause remains a highly personal one, and each woman must be the arbiter of her own risk. But it's important to know there's an arsenal of drugs out there that target menopausal symptoms and if you're feeling bad, your doctor can help.

As Dr. Brizendine is fond of saying: "The change will set you free."

We'll have more from Dr. Brizendine and the "The Brain on Menopause" this week on American Morning.
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