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The New York Times writes that "the relationship between doctor and patient is hard enough to parse when both are in the same room. When one opts out, it becomes even harder. And of the gallons of ink spilled over the centuries in attempts at clarification, few efforts in recent memory lay out the frustrations and confusions and crystalline moments of grace better than Jason Karlawish, MD’s marvelous new book 'Open Wound,' a historical novel tracing the peculiar career of a 19th-century American doctor. Dr. Karlawish, a professor of Geriatrics and Medical Ethics and associate director of the Penn Memory Center, is well attuned to the overtones of his compelling story, from the graphic examples of the principles of autonomy and beneficence to the clear parallels between the rough American frontier and the primitive state of medical research." The New York Times' Science Times also speaks with Dr. Karlawish on their weekly podcast.
New York Times
New York Times podcast
Neurology Today reports from a unique ALS meeting where speakers were asked to be provocative, to shake things up, and to try to find new angles on the pathogenesis of this difficult disease. John Trojanowski, MD, PhD, co-director of the Center for Neurodegenerative Disease Research, proposed a possible convergence point in the spread of protein aggregates from cell to cell. “There is a precedent for transmission” in Parkinson disease and Alzheimer disease, which have patterns of spread through the nervous system that are highly suggestive of cell-to-cell transmission of pathology, he said. His collaborator, Virginia Lee, PhD, has recently demonstrated that purified alpha-synuclein can be taken up by neurons and trigger formation of protein aggregates reminiscent of Lewy bodies. "This could be how ALS progresses once it develops. We think this cell-to-cell spread of neurodegeneration is a whole new, radical concept of the mechanism of these diseases.”
Researchers from the Perelman School of Medicine at the University of Pennsylvania found a new way of diagnosing and tracking Alzheimer's disease, using an innovative magnetic resonance imaging (MRI) technique called Arterial spin labeling (ASL) to measure changes in brain function. The team determined that the ASL-MRI test is a promising alternative to the current standard, a specific PET scan that requires exposure to small amounts of a radioactive glucose analog and costs approximately four-times more than an ASL-MRI. Two studies now appear in Alzheimer's and Dementia: The Journal of the Alzheimer’s Association and Neurology. “In brain tissue, regional blood flow is tightly coupled to regional glucose consumption, which is the fuel the brain uses to function. Increases or decreases in brain function are accompanied by changes in both blood flow and glucose metabolism,” explained John A. Detre, MD, professor of Neurology and Radiology at Penn, senior author on the papers, who has worked on ASL-MRI for the past 20 years. “We designed ASL-MRI to allow cerebral blood flow to be imaged noninvasively and quantitatively using a routine MRI scanner.”
Penn Medicine News Release
USA Today - The over-the-river-and-through-the-woods trip to grandmother's house is prime time to also assess Mom and Dad's health before a crisis occurs, aging experts say. Counseling experts are already witnessing a 66% growth in calls this year from adult children seeking advice on complex medical, legal and financial issues involving aging parents, according to a report being released Wednesday by the ComPsych Corporation, an international provider of 13,000 employee-assistance programs. Add to that high volume the 18% increase during November and December, when families gather after long absences.
The story out of Penn State is so epic, so tragic, the Philadelphia Inquirer wanted to know what scholars of Greek tragedy and Shakespeare had to say about it. Jason Karlawish, MD, professor of Medicine and Medical Ethics, and author of Open Wound, a novel based on the case of a 19th century American doctor, William Beaumont, who both treated and used one of his patients as an experimental subject: "The events seem lifted from the pages of a Greek tragedy. A great and wildly successful man falls as a result of his own blindness to the truth set before him and his willful denial of the power he holds. Now, the Furies are released into his city. The people demand retribution and radical atonement. That Paterno's life story is one of rising up from humble origins to achieve greatness not only for himself but a devoted community only adds to that community's insatiable grief and rage."
The Penn Current covered a newly published JAMA commentary by Zachary Meisel, MD, MPH, MS, an assistant professor of Emergency Medicine, and Jason Karlawish, MD, a professor of Medicine, calling for physicians to incorporate storytelling into the way in which they report research results to the public. “If individuals can link something about the science to a personal experience, it’s more likely to be ‘stickier’ for them,” says Meisel. “They’ll retain the information and put it into a context that allows them act on it. It helps them move from simply getting information to getting it and changing their behavior.” And in cases where negative stories are used to undermine public health initiatives -- such as in public discussion about vaccine safety -- Meisel said narratives can help to set the facts straight. “When stories are used to undermine science, we have to fight fire with fire,” he said.
In the scientific realm, anecdotal evidence—the individual patient, the single result—tends to be shunned in favor of large, dense data sets and impersonal statistical analyses. Although that foundation must remain the core of solid research, examples and narratives should be invoked to round out the explanation of what the hard science says, Zachary Meisel, MD, MS, an assistant professor of Emergency Medicine and Jason Karlawish, MD, a professor of Medicine and Medical Ethics, contended in an essay published last week in JAMA. “Stories are an essential part of how individuals understand and use evidence,” they wrote. And they can have a powerful effect on public opinion and policy, say the authors, both of whom are senior fellows in the Leonard Davis Institute of Health Economics. The Scientific American “Observations” blog covered their piece, along with The Daily Beast, MedCity News, and Science 2.0.
Scientific American blog post
The Daily Beast blog post
MedCity News article
Science 20 article
American Medical News reports that one-third of physician visits include at least one family member in the exam room. Even as the push toward the patient-centered medical home stresses the invaluable role that families can play in improving compliance and health outcomes, the presence of a relative raises a host of complicated issues for physicians to navigate. "Now you've got potentially two patients in the room," says Jason Karlawish, MD, professor of Medicine and Medical Ethics. "You even have a kind of third patient, which is the relationship between the family member and the patient. If you ignore that, you ignore it at your own peril." One step to making the interaction with patients' relatives a positive one is to assess why they came along, says Dr. Karlawish, a geriatrician. "Ask questions," he says. "Just as you ask the patient for their chief complaint, you can turn to the family member and say, 'And you, is there anything in particular that you wanted to bring up?'
American Medical News article
Doctors should consider the use of narrative -- in the form of patient stories and testimonials -- as a powerful tool for translating and communicating evidence-based policies to the public to buoy buy-in on important health issues such as cancer screenings and vaccination mandates, according to two physicians from the Perelman School of Medicine at the University of Pennsylvania writing this week in JAMA. They suggest two strategies: The use of so-called "counternarratives," which can play a role in neutralizing personal stories – often promoted by celebrities via the news media -- that support disproven theories, and narratives about the process of scientific study and discovery, to unmask the often hidden work of researchers and guidelines committees. The commentary is authored by Zachary Meisel, MD, MPH, MS, an assistant professor of Emergency Medicine and a senior fellow in the Leonard Davis Institute of Economics and Jason Karlawish, MD, a professor of Medicine and Medical Ethics and a senior fellow in the Leonard Davis Institute of Health Economics.
Penn Medicine News Release
A story on PennLive.com notes that Lancaster area news anchor Kim Lemon thought her husband had suffered a stroke and took him to the emergency room, where the doctor suggested he had Parkinson’s disease. The couple’s daughters, Meg, 25, and Morgan, 22, began researching their dad’s symptoms online and came across the Neurological Department at University of Pennsylvania. There, at last, John was diagnosed with Lewy body dementia, the second-most common form of progressive dementia after Alzheimer’s disease. Intent on helping others with LBD, John has committed to donating his brain to a research bank at the University of Pennsylvania. “I’m so proud of John. He’s been so brave,” Kim said. “He’s involved in all kinds of research studies and everything he’s taking part in will not benefit him. I have a great deal of respect and empathy for him because he sees and feels his decline and I know he feels a sense of powerlessness.”
Aging Well looks at challenges primary care physicians face when coordinating elders’ care with other physicians who also treat the patient. John Bruza, MD, an associate professor of Geriatric Medicine in the Perelman School of Medicine, says that at Penn all of the health network’s subspecialties use the same EHR system. This has made the management of some highly complex patients much easier. “It facilitates almost instantaneous communication with providers,” says Bruza. In fact, that kind of coordination works so well among complex patients—those seeing multiple doctors on a regular basis—that Bruza says he may encourage certain patients to reconsider an outside specialist they’re seeing in order to try to keep everything within the same health system or network. “That’s not something I’d recommend for the majority of my patients but for those that are quite complex, I might suggest they consider it,” he says.
AlzForum covers new research from the laboratory of Virginia Lee, PhD, director of the Center for Neurodegenerative Disease Research. A major challenge of studying diseases marked by intracellular protein aggregates is getting those pesky clumps to form in the lab under anything resembling realistic circumstances. A study in the October 6 issue of Neuron takes Parkinson’s disease research a step forward in this direction. The Penn team developed a cell model that uses preformed α-synuclein fibrils to induce Lewy body pathology, synaptic dysfunction, and death in wild-type mouse neurons. “The fact that you can take some fibrils, toss them into primary neuron cultures, and recapitulate pathology you see in PD patients suggests you have a simple but powerful system for studying the consequences of α-synuclein pathology in a dish," said Lee.
The possibility that anesthesia and surgery produces lasting cognitive losses has gained attention over past decades, but direct evidence has remained ambiguous and controversial. Now, researchers at the Perelman School of Medicine at the University of Pennsylvania provide further evidence that Alzheimer's pathology may be increased in patients after surgery. "We have long sought a clearer picture of the true impact of anesthesia and surgery on the central nervous system," said lead study author Roderic Eckenhoff, MD, Austin Lamont Professor of Anesthesia at Penn. "Although not definitive, this human biomarker study gives some credibility to the notion that anesthesia and surgery produce an inflammatory insult on the brain and accelerate chronic neurodegenerative diseases like Alzheimer's."
Penn Medicine News Release
New research from the Perelman School of Medicine adds to the growing evidence that anesthesia and surgery may be associated with the progression of chronic brain diseases, particularly Alzheimer's disease. "We have long sought a clearer picture of the true impact of anesthesia and surgery on the central nervous system," study author Roderic Eckenhoff, MD, the Austin Lamont Professor of Anesthesia, said in a HealthDay article. "Although not definitive, this human biomarker study gives some credibility to the notion that anesthesia and surgery produce an inflammatory insult on the brain and accelerate chronic neurodegenerative diseases like Alzheimer's," Eckenhoff added.
USA Today - For people with type 2 diabetes, intense treatment doesn't slow decline in thinking skills, a new study found. Super-strict blood sugar control actually appeared to increase study participants' risk of death, the researchers found. People older than 70 with type 2 diabetes are twice as likely to suffer mental impairment as those without diabetes, researchers say. Intensively controlling blood sugar has been shown to reduce the odds of diabetes complications, such as vision, kidney and circulation problems, so it seemed likely that it might also slow any cognitive decline related to the condition.
USA Today article
USA Today - People with diabetes are at significantly higher risk of developing all types of dementia, including Alzheimer's disease, finds a new study that bolsters previous research connecting the two illnesses. The study of more than 1,000 people in Japan found that 27 percent of those with diabetes developed dementia, compared to 20 percent of people with normal blood sugar levels. Further, the study showed that pre-diabetes -- higher than normal blood sugar levels -- also raised the risk of dementia.
Discover Magazine's science blog "Not Exactly Rocket Science" mentions research published in Neuron from the Center for Neurodegenerative Disease Research, department of Pathology and Laboratory Medicine, about how small amounts of misshapened brain proteins in Parkinson's disease can be taken up by healthy neurons and replicated within them to cause neurodegeneration. Laura Volpicelli-Daley, PhD, senior research investigator, and CNDR Director Virginia Lee, PhD, were both mentioned in the blog.