Richard G. Petty, MD

National Acupuncture Detoxification Association

I had the pleasure and privilege of being on Scott Cluthe’s show on Lime Radio this evening. It’s on Sirius Satellite Channel 114, and if you are interested in the new holistic worldview that is emerging all over the planet, I highly recommend Scott’s show and, in fact, all the shows that I have heard on Lime. I have also had a link to Lime website for some time now, and it always has a great deal of excellent material.

There were some excellent questions from listeners, and one caused me to do some research. The question was about the National Acupuncture Detoxification Association (NADA). The Association is a nonprofit that conducts training and provides public education about the use of acupuncture as an adjunctive treatment for addictions and mental disorders.

There is a substantial body of research literature on the topic of using acupuncture as part of a package of measures for treating substance abuse, and although it is still considered controversial in some quarters, it is being used in over 1,500 places around the world, and that does not include China and Japan, where I have seen acupuncture used a great deal in addictive disorders.

My own experience has been mixed. I have had little success I treating smoking addiction with acupuncture, though I have many colleagues who say that it is extremely helpful. I have had more success in using thought field therapy and homeopathy for treating smoking addiction, even though there is so far no good research data on the use of either for smoking.

If you are interested in the use of acupuncture as an adjunctive treatment for substance abuse, the NADA website if a good place to start.

Work, Stress, Vacations and Exotic Drinks with Little Umbrellas in Them

Your humble reporter has often spoken about his brush with burnout. 

Even though I was a recognized expert on stress – and a former meditation teacher, no less! – I got perilously close to the edge. Fortunately someone noticed and I was packed off on vacation. It was remarkable that just a week in the Caribbean followed by an unforgettable one-week retreat in the Catskills was enough to cure me. My resting pulse rate fell from 68 to 48, where it stayed for more than a year, and I never again had any symptoms. The key point was that the short break was enough to interrupt the downward spiral and provoke the cognitive shift that prevented me from ever again making the mistakes that lead to the trouble in the first place.

I still work hard, but trust me when I say that working 16-17 hours a day, seven days a week is preposterous. Neglecting your emotional health and social life is bad enough. But the last straw was to stop engaging in spiritual practices that I had followed since childhood.

For a long time now I have been teaching that most people can make phenomenal changes in a very short period. It may take you a long time to prepare, but once you are ready change can be extremely quick. If you think about it, the actual physical business of an egg and a sperm joining to make a new life takes less than a minute. But the preparation for the event may take half a lifetime. At least I hope for your sake that it takes a lot longer than a minute…

And that’s all that I am going to say about that…

I was thinking about all this the other day when a stressed executive was telling me that he all he wanted was to spend six months sitting on a beach. In fact that would probably be a thoroughly bad idea.

It is not the time; it is the quality of the time, and the energy that you bring to it.

I cannot stress enough that for most people energy management is far more important than time management.

When it comes to beating burnout, the kind of vacation is likely more important than its length.

A summary of ten years of research by a team lead by Dov Eden, an organizational psychologist from Tel Aviv University's Faculty of Management, was presented at last year's meeting of "Work, Stress and Health" in Miami. The event is sponsored by the American Psychological Association and what Professor Eden had to say really supports what we have been talking about.

For the past ten years the team has been studying "respite effects," which measure relief from chronic job stress during and after vacations away from the workplace. They have also been looking at the impact of constant contact: the revolution in telecommunications has kept some people permanently wired into the office while they are supposed to be away putting their feet up and drinking exotic concoctions with little umbrellas in them. So we are losing true "respite relief," and that in turn is a cause of chronic job stress.

One recent study involved 800 professors from eight Universities in Israel, the United States, and New Zealand. The researchers measured stress levels before, during, and after a sabbatical leave of a semester or a whole year. They compared them with people who stayed home, and others who just took a long weekend or a one-week vacation. They found that those who took a long sabbatical break experienced about the same amount of stress relief as people who had taken either a week off or just a long weekend or long-weekend vacation. And all three groups returned to pre-sabbatical stress levels in about the same amount of time: approximately three weeks.

Some of Eden’s other studies have indicated that people who best succeed in uncoupling from work and detaching form its demands, get the most benefit from their vacations and they probably less likely to experience job burnout. It's the ones who cannot detach from the constant flow of job-related demands that are most likely to suffer from burnout.

The key to a refreshing vacation is to create as much space as possible between you and your work life. I once knew someone who spent a week on Tioman Island in the South China Sea. It is reputed to be one of the most beautiful places on earth, which was one of the reasons why it was selected for the filming of South Pacific. For the whole week she spent all day every day working, and every day the hotel’s fax machine got jammed with the 60-70 pages that she sent out. That is not a recipe for a refreshing, life affirming vacation.

This body of research confirms what most sensible managers have worked out for themselves. When someone goes on vacation they should leave their cell phones behind and not check their email. People who feel attached to the office 24/7 are setting themselves up for long-term stress-related illnesses.

I get a lot more email and phone calls than most normal mortals, yet many years ago I made a remarkable discovery.

I had been out of contact for a week, and even after disposing of the spam and junk mail, there were still well over a thousand messages “demanding” my immediate attention. But during that week away, events had moved on, most no longer needed any input from me at all. Matters had been resolved and solutions found. We lost no business, and I have it on good authority that the earth did not fall into the sun.

I came back rested and restored, and firing on all cylinders: everyone benefited.

Quite obviously it is not a good idea to be completely un-obtainable. I have had two friends, one of whom lost her mother and another his wife, and neither heard the sad news for more than a week. So even when I am in some far flung part of the planet I make sure that there is a way for me to be contacted, But only three people know how.

And I am no longer an electron junkie.

Try it the next time that you have a chance. It really is easier than you think.




“Let all bitterness, and wrath, and anger, and clamor, and evil speaking, be put away from you, with all malice; and be ye kind to one another, tenderhearted, forgiving one another, even as God, for Christ's sake, hath forgiven you.”
--The Bible, Ephesians 4:31-32

“Detach yourself from all that makes your mind restless. Renounce all that disturbs its peace. If you want peace, deserve it.”
--Sri Nisargadatta Maharaj (Indian Spiritual Teacher and Exponent of Jnana Yoga and Advaita Doctrine, 1897-1981)

“You must have been warned against letting the golden hours slip by, but some of them are golden only because we have let then slip by.”
--Sir James Matthew (J.M.) Barrie (Scottish Writer and Playwright, 1860-1937)

Music, Language and the Brain

For more than two centuries neurologists and others interested in music and language have wondered whether or not language and music depend on common processes in the mind. It has been known that some aspects of language and music are represented in different regions of the brain, but there are also many areas of crossover.

Now, researchers at Georgetown University Medical Center have published evidence in the journal NeuroImage, that the processing of music and language do indeed depend on some of the same brain systems.

Their findings suggest that two different aspects of both music and language depend on the same two memory systems in the brain. One brain system, based in the temporal lobes, helps us to memorize information in both language and music, for example words and meanings in language and familiar melodies in music. The other memory system is focused in the frontal lobes, and this one helps us to learn “unconsciously” and use the rules that underlie both language and music, such as the rules of syntax in sentences, and the rules of harmony in music.

The study involved 64 adults and the researchers used a technique called event-related potentials, in which they measured the brain's electrical activity using electrodes placed on the scalp.

The subjects listened to 180 snippets of melodies. Half of the melodies were segments from tunes that most participants would know, such as "Three Blind Mice" and "Twinkle, Twinkle Little Star." The other half included novel tunes composed by one of the researchers. Three versions of each well-known and novel melody were created: melodies containing an in-key deviant note that could only be detected if the melody was familiar, and therefore memorized; melodies that contained an out-of-key deviant note that violated rules of harmony; the original melodies that acted as the “controls”

They found that violations of rules and memory in music corresponded to the two patterns of brain waves seen in previous studies of rule and memory violations in language. In-key violations of familiar melodies led to a brain-wave pattern similar to one called an "N400" that has previously been found with violations of words. One example that the authors gave: :I'll have my coffee with milk and concrete.” Out-of-key violations of both familiar and novel melodies generated electrical activity over the frontal lobe similar to the patterns previously found for violations of rules in both language and music. Out-of-key violations of familiar melodies also led to an N400-like pattern of brain activity, as expected because these are violations of memory as well as rules.

This research opens up new ways of thinking about the relationships between language and music, and may have implications for speech and language therapy.

“When I hear music, I fear no danger. I am invulnerable. I see no foe. I am related to the earliest times, and to the latest.”
--Henry David Thoreau (American Essayist and Philosopher, 1817-1862)

“There is nothing better than music as a means for uplifting the soul.”
--Hazrat Inayat Khan (Founder of the Sufi Order of the West, 1882-1927)

“There are more love songs than anything else. If songs could make you do something we'd all love one another.”
--Frank Zappa (American Composer, Guitarist, Satirist and Song Writer, 1940-1993)

“Since music is a language with some meaning at least for the immense majority of mankind, although only a tiny minority of people are capable of formulating a meaning in it, and since it is the only language with the contradictory attributes of being at once intelligible and untranslatable, the musical creator is a being comparable to the gods, and music itself the supreme mystery of the science of man, a mystery that all the various disciplines come up against and which holds the key to their progress.”
--Claude Lévi-Strauss (Belgian-born French Social Anthropologist, 1908-)

Brain Mapping and ADHD

It is amazing how many people remain resistant to the idea that Attention Deficit Hyperactivity Disorder (ADHD) is a genuine problem. It is likely becoming more common as we live in a progressively more demanding world in which our inner resources can easily become overwhelmed. It is a “real” problem since if it is severe it can cause suffering and second, ADHD can also be associated with a range of other difficulties. There is also more and more evidence that it is associated with robust disturbances in the structure and functioning of the brain.

There is an important study published in Human Brain Mapping that reveals an association between ADHD and a decrease in cortical volume, surface area and folding throughout the brain. Researchers from the Kennedy Krieger Institute in Baltimore, Maryland, found that children with ADHD has decreased total brain volume and decreased volume throughout the cerebral cortex. What is new is that the reduction in cortical volume seems to be the result of decreased folding in the cortex. This in turn suggests that folding – a process that starts around the 14th-16th weeks of pregnancy and continues into infancy - is the key structural brain feature associated with ADHD.

The investigators examined 21 children with ADHD aged 8-12 years, and a control group of 35 unaffected children matched for age and gender. The children with ADHD had more than 7 percent reduction in total cerebral volume compared with the control group.

One of the design problems in human beings is that the brain is encased in a hard skull that moves little. So once the brain has grown to fill the skull, the only way to increase the surface area of the brain is for the cortex to become more folded. The whole process of cortical folding is crucial to increasing the structural and functional capacity of the brain.

This is of great interest, particularly in light of the study just published in the Proceedings of the National Academies of Sciences that indicates that the brain of people with ADHD can catch up later. That study did not look at brain folding, so it will be interesting to see exactly how the brain can catch up, and how we might be able to give it a helping hand.

Nutrigenetics: A Peak Into the Future

At any given time only about ten percent of you genes are thought to be active. They are switched on and off in response to all kinds of internal and environmental changes. This is particularly true in the metabolic pathways, where gene activation is an essential part of the normal response to dietary changes. We also know that many of us have genetic reasons for varying in our nutritional requirements.

Anybody who has looked into diet and nutrition knows that there is no one approach that works for everyone, and the Holy Grail of weight management is to be able to identify which diet will work for whom.

This goal has just come a little closer with the publication of a report from researchers in Greece, London and Colorado that has been published in the Nutrition Journal.

The paper, “Improved weight management using genetic information to personalize a calorie controlled diet” is available for free download.” The study population consisted of 50 patients who had failed to lose weight. They were offered a nutrigenetic test screening 24 variants in 19 genes involved in metabolism. 43 patients attending the same clinic were selected for comparison using algorithms to match age, sex, frequency of clinical visits and BMI at initial clinic visit. The second group of 43 patients did not receive a nutrigenetic test. BMI reduction at 100 and over 300 days and blood fasting glucose were measured.

The results are very promising. After 300 days of follow-up individuals in the nutrigenetic group were more likely to have maintained some weight loss (73%) than those in the comparison group (32%). Average BMI reduction in the nutrigenetic group was 1.93 kg/m2 (5.6% loss) vs. an average BMI gain of 0.51 kg/m2 (2.2% gain). Among patients with a starting blood fasting glucose of >100 mg/dL, 57% (17/30) of the nutrigenetic group but only 25% (4/16) of the non-tested group had levels reduced to <100 mg/dL after >90 days of weight management therapy.

The paper concludes by saying that the addition of nutrigenetically tailored diets resulted in better compliance, longer-term BMI reduction and improvements in blood glucose levels.

This is a small “proof of concept” study, and the effects are not enormous, but there is easily enough here already to vigorously pursue this genetic approach.

A New Lie Detector?

I am sure that this is a story that is going to be picked up and re-worked by those excellent writers over at Law and Order.

An academic at the University of Sheffield has used groundbreaking technology to investigate the potential innocence of a woman convicted of poisoning a child in her care.

Professor Sean Spence, who is a pioneer in the use of functional Magnetic Resonance Imaging (fMRI) to detect lies, carried out the experiments on the woman who, despite protesting her innocence, was sentenced to four years in prison. His results have now been published for the first time in the journal European Psychiatry.

Sean examined the woman’s brain activity as she alternately confirmed her account of events and that of her accusers. The tests demonstrated that when she agreed with her accusers´ account of events she activated extensive regions of her frontal lobes and also took significantly longer to respond: these findings have previously been found to be consistent with false or untrue statements.

Although the technology has previously been claimed to be 90% accurate, which is far superior to “lie detector" – polygraph – tests, its use has also been open to debate. Lie detection tests are already used regularly in parts of the United States justice system, as well as by businesses. But as far as I know, these are the first brain scanning tests of their kind, carried out on a real-life case, reported in the world literature.

Professor Spence said:

"This research provides a fresh opportunity for the British legal system as it has the potential to reduce the number of miscarriages of justice. However, it is important to note that, at the moment, this research doesn’t prove that this woman is innocent. Instead, what it clearly demonstrates is that her brain responds as if she were innocent."

"If proved to be accurate, and these findings replicated, this technology could be used alongside other factors to address questions of guilt versus innocence."

Blondes Makes Us Dumb??

No, this isn’t just a cheap excuse to display a picture of Pamela Anderson.

I just received this from a regular reader:

"Dear Dr Petty,

Have you seen this article Times Online?

“WHEN men meet fair-haired women they really do have a “blonde moment”. Scientists have found that their mental performance drops, apparently because they believe they are dealing with someone less intelligent.

Researchers discovered what might be called the “bimbo delusion” by studying men’s ability to complete general knowledge tests after exposure to different women. The academics found that men’s scores fell after they were shown pictures of blondes.

Further analysis convinced the team that, rather than simply being distracted by the flaxen hair, those who performed poorly had been unconsciously driven by social stereotypes to “think blonde”.

“This proves that people confronted with stereotypes generally behave in line with them,” said Thierry Meyer, joint author of the study and professor of social psychology at the University of Paris X-Nanterre. “In this case blondes have the potential to make people act in a dumber way, because they mimic the unconscious stereotype of the dumb blonde.”

Do you have any comment to make about the research??"

The answer is that I have seen this article all over the Internet, with all kinds of sage comments.

The trouble is that I have not yet been able to read and critique the research. As far as I know, neither the hard copy nor electronic versions are available yet, so I cannot evaluate the report.

This highlights one of the problems of the Internet: news travels across it like the wind, yet a lot of material is passed on without analysis. So the story is fun to read, but until we can see and analyze the data, we cannot comment.

As soon as I get a copy I shall see if I have anything to add to the firestorm of commentary!

Talking with Your Hands

In recent years there has been a small but growing literature that seems to support an idea going back to Roman times: certain specific movements may facilitate learning and a number of positive mental states.

Now, according to research from the University of Chicago that is reported in this month’s issue of Journal of Experimental Psychology: General gesturing can help children to learn new and correct mathematical problem-solving strategies. And the learning sticks: if they are taught new material later, children taught to gesture are more likely to succeed on math problems.

The investigators conducted two studies of 176 children in late third and early fourth grade, all of whom had been making mistakes in solving math problems. The children were randomly assigned the students to three groups:

1. Told to gesture
2. Told not to gesture
3. Not told to do either

In the studies' baseline phase, students had to solve six age appropriate math problems on a chalkboard and explain to an experimenter how they solved each one. The researchers coded the children's videotaped efforts, analyzing gestures and utterances that conveyed problem-solving strategies.

Compared with the children who were not told to do anything, those who were told to move their hands when explaining how they had solved a problem were four times as likely to manually express correct new ways to solve problems. They still did not give the right answer, but their gestures revealed an implicit knowledge of mathematical ideas. As one example, if the problem needed for the sides to be equal, children might sweep their palm first under a problem's left side and then under its right side. So they had implicit knowledge. Their problem was in turning explicit knowledge into correct answers. The second study showed that gesturing prepared them to benefit from subsequent instruction. Children told to gesture solved 1.5 times more problems correctly compared with the children who had been told not to gesture.

The authors conclude,

"Telling children to gesture encourages them to convey previously unexpressed, implicit ideas, which in turn makes them receptive to instruction that leads to learning."

Gesturing appears to help children to produce new problem-solving strategies, which in turn gets them ready to learn. The authors speculate that gesturing may help kids notice aspects of the math problems that may be more easily grasped through gestural representation

The findings extend previous research that body movement not only helps people to express things they may not be able to verbally articulate, but actually to think better. At the same time, gesturing offers a potentially powerful new way to augment the teaching of math. Strategies for math problems have focused on externalizing working memory, such as writing things down in certain ways. However, children often find it hard to recall and use those strategies. Gesturing may be more accessible, and help break through the roadblock.

This makes sense: we are hardwired to learn motor actions. That was an important skill long before the first person learned the basics of arithmetic. It is quite well known in educational circles that when it comes to learning, “doing” is 2-3 times more efficient than “listening.” But even “doing” is nowhere near as good as questioning, being questioned and then teaching.

(The entire article is available for free download here.)

“He who wishes to teach us a truth should not tell it to us, but simply suggest it with a brief gesture, a gesture which starts an ideal trajectory in the air along which we glide until we find ourselves at the feet of the new.”
--José Ortega y Gasset (Spanish Philosopher, 1883-1956)

Mature Plasticity in the Human Brain

The more we look, the more we understand that the human brain retains a remarkable ability to learn and re-fashion itself well into old age. The old idea that young brains are flexible, but that age causes us to become “hard-wired” and inflexible is not correct.

This has been confirmed in some new research that has just been published in the journal Neuron by investigators from Johns Hopkins who have shown that adult neurons are not glued in place as rigidly as had been thought.

The investigators led by David Linden used a new technique known as two-photon microscopy that allowed them to living neurons at work in the intact brain. The researchers injected fluorescent dye into the brains of mice to illuminate a subset of neurons and then viewed these neurons through a window in the skull of living, anesthetized mice.

They examined neurons that extend axons to the cerebellum, a region of the brain involved in coordinating motor and sensory information. These axons have a primary trunk that runs upward and several smaller branches that sprout out to the sides.

While the main trunk was firmly connected to other target neurons in the cerebellum, the side branches were mobile: Linden describes them like this:

"The side branches swayed like kite tails in the wind."

Over the course of a few hours, individual side branches would highly dynamic behavior, elongating, retracting and morphing. These side branches also failed to make conventional synaptic connections with adjacent neurons. The motion of the side branches was arrested stalled by a drug that produced strong electrical currents in the axons.

Why the brain would want such motile, non-connected branches remains a mystery.

They may provide a second mechanism for conveying information beyond traditional synapses. Alternatively they may be involved in nerve regeneration.

Whatever the final answer, it is clear that the adult brain remains a remarkably plastic, fluid and flexible structure.

Excellent news for all of us!

“That which is flexible and flowing will prosper and grow. That which is rigid and blocked will wither and die.”
--Tao D Ching

“When a noble life has prepared old age, it is not decay that it reveals, but the first days of immortality.”
--Muriel Spark (Scottish Writer, 1918-)

"You will stay young as long as you learn, form new habits and don’t mind being contradicted.”
--Marie, Baronin von Ebner-Eschenbach (a.k.a. Baroness Marie von Ebner-Eschenbach, Austrian Writer, 1830-1916)

Attention Deficit Disorder and the Growing Brain

An extremely important article by researchers from the National Institute of Mental Health has just been published in the Proceedings of the National Academies of Sciences. It suggests that children with Attention Deficit Hyperactivity Disorder (ADHD) have brains that develop more slowly than those of children without ADHD. However in most cases they still follow a normal pattern of development.

In a study of 450 children, 225 of whom had ADHD, the researchers found that the cerebral cortex of children with ADHD developed about three years more slowly.

The primary measure that they used was the peak thickness of the brain, which is normally taken to be a sign of maturity. Half of the children with ADHD reached peak thickness when they were an average of 10.5 years old, compared with 7.5 years among children without ADHD.

Even if the brain is developing more slowly, the fact that it appears to grow normally is reassuring, and may explain why a substantial proportion of children with ADHD do grow out of it as they get older. Though it still leaves us with several questions:

• Why does the delay occur at all?
• Why do so many people NOT grow out of it, and have persistent symptoms in adulthood?
• Is the brain really “catching up?” The brains of people without ADHD also continue to develop and grow

The National Institute of Mental Health has also published a nice press release that includes a video of brain maturation. You can find it here.

Blood Pressure and the Seasons

High blood pressure may be more difficult to control in winter, according to research reported to the American Heart Association, at its meeting in Orlando last week.

A five-year study by a team from the United States found Department of Veterans Affairs analyzed data on 443,632 veterans treated for hypertension at 15 VA hospitals in cities throughout the US found that blood pressures during the summer were on average 7.76% lower than during the winter. The researchers found the same pattern emerged from each hospital they studied, regardless of whether it was based in a warm or cold climate, in locations that ranged from Anchorage, Alaska to San Juan, Puerto Rico.

This is an intriguing finding, and there are a load of potential explanations for it:
A more active summer lifestyle may be the key
It is also possible that people might eat more salty foods in winter, and salt is strongly linked to raised blood pressure
There may also be a link with sunlight. Which can trigger a number of metabolic changes

But I also need to sound a note of caution: blood pressure changes all the time throughout the day. Although the study was all done correctly, it is important to realize that many subtle variations in blood pressure could be lurking within the data.

Nonetheless, people should be aware of the possibility that their blood pressure may be harder to control in the winter, and to be more vigilant at this time.

“For everything there is a season, And a time for every matter under heaven: A time to be born, and a time to die; A time to plant, and a time to pluck up what is planted; A time to kill, and a time to heal; A time to break down, and a time to build up; A time to weep, and a time to laugh; A time to mourn, and a time to dance; A time to throw away stones, and a time to gather stones together; A time to embrace, And a time to refrain from embracing; A time to seek, and a time to lose; A time to keep, and a time to throw away; A time to tear, and a time to sew; A time to keep silence, and a time to speak; A time to love, and a time to hate, A time for war, and a time for peace.”
--The Bible, Ecclesiastes, 3:1-8

“Each new season grows from the leftovers from the past. That is the essence of change, and change is the basic law.”
--Hal Borland (American Writer, 1900-1978)

“Live in each season as it passes; breathe the air, drink the drink, taste the fruit, and resign yourself to the influences of each. Let them be your only diet drink and botanical medicines.”
--Henry David Thoreau (American Essayist and Philosopher, 1817-1862)

Emotional Eating

A new study from Miriam Hospital's Weight Control and Diabetes Research Center in Providence, Rhode Island, has just been published in the journal Obesity. The research suggests that dieters who tend to eat in response to external factors like parties and celebrations, have fewer problems with their weight loss than those who eat in response to internal factors such as emotions. The study also found that emotional eating was associated with weight regain in people who had successfully lost weight

The researchers analyzed individual's responses to questions in a well-known research tool called the Eating Inventory which is designed to assess three aspects of eating behavior:

1. Cognitive restraint
2. Hunger
3. Disinhibition

The main focus was on the third item, since some previous research has suggested that disinhibition as a whole is an accurate predictor of weight loss.

The disinhibition scale evaluates impulsive eating in response to emotional, cognitive, or social cues.

There were two groups in the study. The first consisted of 286 overweight men and women who were currently participating in a behavioral weight loss program. The second group included 3,345 members of the National Weight Control Registry (NWCR), an ongoing study of adults who have lost at least 30 pounds and kept it off for at least one year. 

The investigators found that the components within the disinhibition scale could be grouped into two distinct factors: external and internal disinhibition.

An example of external disinhibition would be the person who overeats when they are with someone who is also overeating, or the person who just overeats at a party, picnic or celebration.

The person with internal disinhibition eats in response to thoughts and feelings such as loneliness, upset or anxiety.

In both groups internal disinhibition was a significant predictor of weight over time. For participants in the weight loss program, the higher the level of internal disinhibition, the less weight an individual lost over time. The same was true for maintainers in the NWCR: Internal disinhibition predicted weight regain over the first year of registry membership.

Before starting a weight management program it is very helpful to know which group you are in. It provides us with a quick and easy method of tailoring the program to the individual, and tells us where to put our efforts.

More Genes Involved in Obesity

I am impressed by the progress being made by some of my former colleagues who are busily unraveling the complex genetics of obesity.

In a paper in the journal Science a group of British scientists including Chris Ponting of the Medical Research Council Functional Genetics Unit in Oxford and Stephen O'Rahilly’s group at the  University of Cambridge, has made a second breakthrough in twelve months in understanding how a gene triggers weight gain in some individuals. In May we looked at the first piece of work on the gene called “FTO.”

At that time we learned that variations in the FTO gene influence people's risk of becoming obese. This particular gene was of great interest because the genetic variant in FTO that predisposes to obesity is very common in the population.

About half the British population carries a copy of the variant and they are on average 3-4 pounds heaver than those who do not have it. The 16 per cent of the population who carry two copies of the variant and are on average 6-7 pounds heavier. We also learned that carriers of the variant have an increased risk of diabetes. However the function of FTO was completely unknown.

The new paper shows that the FTO gene codes for an enzyme - 2-Oxoglutarate-Dependent Nucleic Acid Demethylase - that can act directly on DNA. This strongly suggests that FTO might have a role in controlling how and when genes are turned on and off.

The investigators also found that FTO is highly expressed in the hypothalamic region of the brain, which has important roles in the control of hunger and satiety. In certain areas of the hypothalamus, the levels of FTO are influenced by feeding and fasting.

This is a remarkable finding. That a gene involved in obesity and diabetes has a direct effect on DNA in specific regions of the brain is very exciting. It suggests that the gene is involved in influencing how well the brain senses hunger and fullness. Small molecules derived from metabolism can modulate the activity of FTO, so we can see a direct link form food to metabolism to DNA in the brain.

The findings raise all kinds of treatment possibilities and also confirm something that I have been teaching for three decades: weight control does not start with a diet. It starts between the ears. Until you have been shown how to re-program your brain, thoughts and emotions, your chance of successfully controlling your weight is, ahem, slim.

The Looming Crisis of Alzheimer’s

For those of us who lobby for resources, it is no overstatement to say that Alzheimer's disease has reached crisis proportions in the United States.

As we are getting older, the incidence, prevalence and mortality of Alzheimer’s disease are all rising.

The 2007 Alzheimer's Disease Facts and Figures report by the Alzheimer's Association makes sobering reading. Here are some of the headline facts:

• Alzheimer's disease is the most common cause of dementia
• At the present rate, one in 85 people will have the disease in 40 years
• There are now more than 5 million people suffering from Alzheimer's disease, and the report projects an increase of 16 million cases by 2050 unless preventive measures are taken and/or science is able to come up with a prevention or cure
• One person is now diagnosed with dementia every seven seconds
• One in every four American families is affected by dementia
• The incidence of dementia is one in 1,000 before age 65 and one in 20 after age 65.
• More than $100 billion is spent per year on dementia, which is about 10 percent of all healthcare expenditures

As we have discussed before, the symptoms of dementia may be delayed for 3 to 5 years through healthy lifestyles and behavior modification, and there are many new treatment approaches in the pipeline.

The huge issue is that statistic about one in four families being affected by the disease. And it is a disease: it is not part of normal aging.

Caregivers can suffer terribly.

The Alzheimer’s Association also has some information for those who care for people with Alzheimer’s.

There is also some food information here concerning caregiver stress.

I would also like to direct you to some of the things that I have written here about the wellness of caregivers.

And for everyone, don’t wait until you are thirsty before you dig that well. Work on building you personal resilience and follow the simple lifestyle guidelines that may significantly reduce your risk of developing Alzheimer’s disease.

Career Contentment Radio

Later today I have the privilege of speaking to Jeff Garton and Cathy Yin on Career Contentment Radio, which is broadcast by Business Voice America.

We are going to be talking about one of my favorite topics: Building Resilience.

This program goes out live at Noon Pacific, which is 3PM Eastern, and is rebroadcast at Midnight Pacific time.  It will then be available on demand and podcast ready.

I have already sent out e-card invitations with the links to people on my list. If you did not get one, please let me know.

Later today I shall also be posting a report on "Building Resilience" on my main website with more free resources for you to use.

Close Your Eyes and I’ll…

Every young neuroscience student learns about a classic experiment that was published in 1956 by Raul Hernandez-Peon, in which he had an electrode in the acoustic nerve of a cat, while a metronome was ticking. Every tick caused a pulse of electricity in the nerve. But as soon as the cat saw or smelled a mouse, the electrical activity plummeted: now all of his attention was on lunch, and his brain damped down the unnecessary ticking of the metronome. Something similar happens with the “Cocktail Party Phenomenon:” our ability to focus our listening attention on a single talker and ignoring other conversations that are going on.

A study by researchers from Wake Forest University Baptist Medical Center and the University of North Carolina was presented at the Society for Neuroscience conference in San Diego this week, suggesting that our brains can turn down our ability to see, so that we are better able to listen and focus on music and complex sounds.

The research used functional Magnetic Resonance Imaging in 20 non-musicians and 20 musical conductors aged 28-40, and found that both groups diverted brain activity away from visual areas during listening tasks. The activity fell in the visual regions areas as it rose in auditory ones. But during harder tasks the changes were less marked for conductors than for non-musicians.

While being scanned the subjects were asked to listen to two different musical tones played a few thousandths of a second apart and identify which was played first. The task was made harder for the professional musicians than for the non-musicians, to allow for the differences in their background.

As the task was made progressively more difficult, the non-musicians carried on diverting more and more activity away from the visual parts of the brain to the auditory, as they struggled to concentrate on the music. However, the conductors did not suppress their brains, suggesting that their years of training had given them an advantage in the way that their brains were organized and functioning. They are less likely to be distracted and are highly tuned to musical sounds.

This is like closing your eyes to listen to music and the advantage of the trained musicians is similar to the advantage that we see in the brain of the chess master compared with the amateur. Years of study and practice enable the chess player to move without much conscious thought.

It shows how well we are able to divert activity from one part of the brain to another as needed. It is that ability to be flexible and to recruit more brain when we need it that lies at the heart of the neurocognitive revolution that is changing the way that we think about the brain and mind.

Genes, Breastfeeding and IQ

Studies on intelligence and breastfeeding have come up with conflicting results. The major question has been whether the results have been skewed because more educated or more affluent mothers were more likely to breastfeed.

A new study by colleagues in London, New Zealand and here in the United States has just been published in the Proceedings of the National Academies of Sciences and indicates that a single gene influences whether breastfeeding improves a child's intelligence.

The gene in which the researchers were interested is a fatty acid delta desaturase – FADS2 – that is involved in the genetic control of fatty acid pathways. Children with one version of the FADS2 gene scored seven points higher in IQ tests if they were breastfed, but breastfeeding had no effect on the IQ of children with a different version of the gene.

Researchers at the Institute of Psychiatry, Kings College London, used data from two previous studies of breast-fed infants in Britain and New Zealand that had involved more than 3,000 children. IQ was measured at various points between the ages of five and 13 years in the studies. The only thing that we do not know is exactly how long the children were breastfed.

This is yet another study to show us why the nature/nurture debate needs a radical re-think. Nutrition and genetics act together. People have been arguing about the roots of intelligence for at least a hundred years, and this research shows nature working via nurture to create better outcomes.

Around 90% of people carry the version of the gene that was associated with better IQ scores in breastfed children. We do not know if there are any ethnic differences in those numbers, but there may be.

And that seven point difference in IQ? It s not going to determine how well someone is going to do in life, but in school it might be enough to put the child in the top third of the class.

Unhealthy America

The Milken Institute has released an impressive study that shows the heavy economic burden chronic disease places on our nation. “An Unhealthy America: The Economic Burden of Chronic Disease” shows the current treatment costs of seven chronic diseases - cancers, diabetes, heart disease, hypertension, stroke, mental disorders and pulmonary conditions – as well as the economic impacts of lost workdays and lower employee productivity. It gives a breakdown across all 50 states and the nation as a whole. The study finds that the annual economic impact on the U.S. economy of the most common chronic diseases is more than $1 trillion, and projects that the figures could reach nearly $6 trillion by the middle of the century.

Though some of the blame for this burden can be blamed on stress and environmental factors, much more of it is a direct consequence of our lifestyle choices interacting with our genes. Most of us are failing to renew, refresh and replenish ourselves, and it is important to recognize that whenever we start debating the costs of health care in the United States.

Integrated Health is based on tailored systems to help people care for themselves by going way beyond diet and exercise, and addressing the psychological, social, cultural, subtle and spiritual components of health and wellness. Healing, Meaning and Purpose is a detailed roadmap for creating the life that you deserve, and we are going to be rolling out a new series of teleseminars and workshops in the New Year.

The Dangers of Health Screening

We have talked before about the problems of interpreting blood and other tests. Yet in this land of defensive medicine, most wise physicians have to do an awful lot of screening that is not always in the patient’s best interests.

Here is a recent article from Forbes that looks at seven health screens about which we should, perhaps, think twice:

1. Total body scans
2. PSA screen for prostate cancer
3. CT scan for lung cancer
4. PlacTest to evaluate your chance of a heart attack or stroke
5. Coronary calcium scans
6. CA125 tests for ovarian cancer
7. Vitamin D testing

Controversial stuff, and I can think of a number of other tests about which I have a great many reservations.

The problem is that every advocacy group has a slightly different set of recommendations on screenings. Doctors and patients are getting conflicting and confusing messages about which tests to use.

The second issue is false positives. Even recommended tests yield many false readings. According to research compiled by the United States Agency for Healthcare Research and Quality,  the percentage of false-positive mammograms is between 7% and 8% for women aged 40 to 59 who took the test. The figure drops to around 4% for women 60 to 79, presumably because the chances of getting breast cancer rise as women age. The conclusion is that if every woman between 40 and 59 in the U.S. had a mammogram, a few million would be fretting unnecessarily over a wrong result.

My life’s work has centered on wellness and the prevention of illness, so I would never want to abandon screening. We just need to be very aware of the pros and cons of any tests that we do.

Mold, Dampness and Depression

It matters where you live.

I have lived or stayed in many countries, and there is no doubt that some places are a lot more congenial than others. I don’t just mean a beach in Thailand compared with the North of Scotland in winter. Some places just make you feel better. There are many physical, psychological, social and subtle reasons, but here is a relatively new one.

There is an important paper in this month’s issue of the American Journal of Public Health looking at the possibility of a link between dampness and mold in the home and clinical depression.

Molds are fungi that are found in many environments but most of them grow best in warm, damp, and humid conditions. Therefore, dwellings that have problems with damp also commonly have problems with mold. Although the physical health consequences of living in a damp and moldy dwelling are quite well known, the effect of living in such an environment on mental health has not.

Some of the known health problems associated with high levels of airborne mold spores include^:

• Allergic reactions
• Asthma
• Irritations of the eyes, nose and throat
• Sinus congestion and other respiratory problems
• In people with with weakened immune systems, inhaled mold spores may germinate, attaching to cells along the respiratory tract
• Immunocompromised individuals exposed to high levels of mold may get a systemic fungal infection
• Infections of the digestive tract, lung and skin

The researchers used survey data from 8 European cities. They created a dampness and mold score from resident- and inspector-reported data. Depression was assessed using a validated index of depressive symptoms.

The results showed that dampness and mold were associated with depression, independent of individual and housing characteristics. This association was independently mediated by perception of control over one's home and by physical health.

This link is most likely because of the psychological and physiological consequences of living in poor housing conditions. But there could also be a direct pathological effect of mold itself.

Resting Racehorses

Your humble reporter lives on a horse farm, and many of our equine friends compete on a regular basis, so we are always interested in anything to keep them fit, healthy and happy.

I was interested to see a report of some research done in Finland. The main carbohydrate store in muscle is called glycogen, and Seppo Hyyppä, from MTT Agrifood Research Finland, looked at the way in which muscle glycogen stores are rebuilt after exercise. This is an important question, and not only for horses: glycogen is the most important nutrient during exercise and if glycogen stores are depleted the horse breaks down the protein in its own muscles to provide energy. So if the horse is chronically over-exercised it can hurt him.

The two most important factors in rebuilding muscle glycogen were:

• Sufficient recovery time between intense training periods, and
• Hydration

Giving horses an isotonic glucose-electrolyte rehydration solution soon after exercise helps to overcome dehydration significantly better than providing them with plain water.

The research also showed that weighing the horse before and after exercise gave a reasonably accurate estimate of the rate at which glycogen was being replenished. If you don’t have a set of weighing scales handy, you can measure the horse’s chest circumference.

The research also confirmed what every horse owner knows: you can tell a lot by looking at a horse: his general alertness and, for example, suppleness and appetite, indicate that he is in good condition.

“A canter is the cure for every evil.”
--Benjamin Disraeli, 1st Earl of Beaconsfield (English Statesman, Novelist and, in 1868 and from 1874-1880, British Prime Minister, 1804-1881)

“A man on a horse is spiritually as well as physically bigger than a man on foot.”
--John Steinbeck (American Writer and, in 1962, Winner of the Nobel Prize in Literature, 1902-1968)

Fat and Cancer

It is not every day that a medical story hits the front page of USA Today, but today one has, and for a very good reason.

The World Cancer Research Fund (WCRF) has just published a report that we have been eagerly awaiting for several years. It is the most comprehensive analysis ever published on the link between cancer and diet, weight and physical activity. Researches at nine academic institutions across the world looked for every relevant study published since records began in the 1960s. They initially found half a million, and in the end 7,000 of them were judged to be the most relevant and robust for inclusion in the report.

It includes 10 recommendations from a panel of 21 world-renowned scientists that represent the most definitive and authoritative advice that has ever been available on how the general public can prevent cancer. UNICEF and the World Health Organization were among the official observers of the report's process.

A key finding is that maintaining a healthy weight (a BMI of 20-25) is one of the most important things you can do to prevent cancer. The number of types of cancer where there is "convincing" evidence that body fat is a cause has risen from one to six since the last WCRF report was published in 1997, including colorectal cancer and post-menopausal breast cancer.

Prof Sir Michael Marmot, who was Chair of the Panel, said that,

“We are recommending that people aim to be as lean as possible within the healthy range, and that they avoid weight gain throughout adulthood.

"This might sound difficult, but this is what the science is telling us more clearly than ever before. The fact is that putting on weight can increase your cancer risk, even if you are still within the healthy range.

"So the best advice for cancer prevention is to avoid weight gain, and if you are already overweight then you should aim to lose weight."

Other findings in the report include:

There is "convincing" evidence that processed meats, including ham and bacon, increase the risk of colorectal cancer. People who consume them are advised to do so sparingly.

The evidence that red meat is a cause of colorectal cancer is stronger than ever before. People should not eat any more than 18 ounces (500g) of red meat a week.

This figure is for cooked meat, and is the equivalent of between 15-30 ounces (700-750g) of non-cooked meat.

Here is something that is almost a first, at least for a cancer report. It has made a breastfeeding recommendation: mothers are advised to breastfeed exclusively for six months and to continue with complementary breastfeeding after that. This is because of "convincing" evidence that breastfeeding protects the mother against breast cancer and "probable" evidence that it protects the child against obesity later in life.

Dietary supplements are not recommended for cancer prevention. The evidence that alcohol is a cause of cancer is stronger now than ever before.

Professor Martin Wiseman, Project Director of the Report, said:

"This report is a real milestone in the fight against cancer, because its recommendations represent the most definitive advice on preventing cancer that has ever been available anywhere in the world.

"When individual studies are published, it is impossible for the public to put them into context and know how seriously they should be taking the findings. But the great thing about this report is that it does this job for them.

"If people follow our recommendations, they can be confident they are following the best advice possible based on all the scientific research done up to this point. These recommendations are not based on one study but are based on 7,000." 

In the United Kingdom, plans are afoot to establish a Cancer Reform Strategy. Professor Mike Richards, the British Government's Clinical Director for Cancer, had this to say:

“The WCRF report is the most authoritative and exhaustive review done thus far on the prevention of cancer through food, nutrition and physical activity.

"For those of us wanting to lower our risk of developing cancer, the Report provides practical lifestyle recommendations. The Report also provides public health goals. Both will form an important element for the forthcoming Cancer Reform Strategy."

These are the main recommendations:

• Limit red meat
• Limit alcohol
• Avoid bacon, ham, and other processed meats
• No sugary drinks
• No weight gain after 21
• Exercise every day
• Breastfeed children

Have you seen those infomercials where someone tells you that there is some conspiracy by shadowy people who don’t want you to know the truth about diet, exercise and cancer?  Next time remember this research. If some expensive supplement or the juice of an exotic berry from the Himalayas could really reduce the risk of cancer, these studies should have noticed something by now.

Nutrition and Female Fertility

Whoever said that “you are what you eat” was not wrong. The composition of our diets can affect everything from our moods to our risk of getting some types of cancer.

Now it looks as if nutrition may also be an essential part of helping at least one type of infertility.

There are literally hundreds of causes of infertility, but one of the more common ones in women is a problem with ovulation. A rapidly growing cause of ovulatory problems is the polycystic ovarian syndrome, which is itself associated with insulin resistance.

New research from Harvard School of Public Health is published today in the prestigious journal Obstetrics & Gynecology which suggests that women who followed a combination of five or more lifestyle factors, including changing specific aspects of their diets, had more than 80 percent less relative risk of infertility due to ovulatory disorders when compared with women on more unhealthy diets.

The investigators followed a group of 17,544 married women who were participating in the Nurses' Health Study II, which is based at the Brigham and Women's Hospital in Boston. The researchers created a scoring system on dietary and lifestyle factors that previous studies have found to predict ovulatory disorder infertility. Among those factors were:

• The ratio of mono-unsaturated to trans fats in diet
• Consumption of animal or vegetable protein consumption
• Carbohydrates consumption, which included both dietary fiber the glycemic index of foods
• Dairy consumption: both low- and high-fat
• Iron consumption
• Multivitamin use
• Body mass index
• Level of physical activity

The researchers then assigned a "fertility diet" score of one to five points. The higher the score, the lower the risk of infertility associated with ovulatory disorders.

The women with the highest fertility diet scores ate:

• Less trans fat
• Less sugar from simple carbohydrates
• More vegetable than animal protein
• More fiber and iron
• More multivitamins
• More high-fat dairy products and less low-fat dairy products

The more fertile women also had a lower BMI and exercised for longer periods of time each day.

This relationship between a higher "fertility diet" score and lesser risk for infertility was similar for different subgroups of women. It seemed to hold in many different age groups, and whether or not a woman had been pregnant in the past.

The effect size is impressive: women following five or more low-risk dietary and lifestyle habits have a six fold reduction in ovulatory infertility risk compared with women following none of them.

There are two surprises here. It has been believed that heavier – though not obese – women tended to be more fertile. That is not what this study found. Second,  the higher fertility rates of women who consume high-fat dairy products and less low-fat dairy products may seem counter-intuitive. But well-nourished women would be expected to have a higher chance of being fertile.

The take home message is this: if a woman is having problems with ovulation, sensible dietary choices and a moderate amount of physical activity may make a large difference in her chance of becoming fertile.

This all makes sense. From an evolutionary perspective it could be dangerous to bear a child while ingesting foods, chemical or toxins that could harm a baby, or could compromise the health of a pregnant mother.

"Nutrition can be compared with a chain in which all essential items are separate links. We know what happens if one link of a chain is weak or is missing. The whole chain falls apart.”
--Patrick Wright (American Director of the Institute for Research on Food-related Disease)

“Health requires healthy food.”
--Roger Williams (Indian-born American Chemist who did pioneering work on the Vitamin B Complex, 1893-1988)

The Mile High Club

Your humble reporter just saw this on the BBC website:

“Airline bans A380 mile-high club

Singapore Airlines has taken the unusual step of publicly asking passengers on its new Airbus A380 plane not to engage in any sexual activities.

The potential problem has arisen because the first class area of its giant super-jumbo contains 12 private suites complete with double beds.

Singapore, which is the first airline to start flying the A380, said the suites were not soundproofed.

It said it did not want anyone to offend other travelers or crew.

Singapore added that while the suites were private, they were also not completely sealed.

"All we ask of customers, wherever they are on our aircraft, is to observe standards that don't cause offense to other customers and crew," the airline said in a statement.”

Does this mean that Singapore Airlines is going to do something with Virgin?


Richard Branson: Care to comment????!

Breathing Problems During Sleep and the Heart

We have talked about the importance of heart rate variability (HRV), which reflects the activity of many critical bodily functions. HRV is the result of a subtle interplay between the heart and the nervous system, and abnormalities in HRV may be an early warning of severe illness and even of death.

There are many reasons why peoples’ breathing can become disturbed during the night, and it is essential to be sure that we are treating the right thing.

In obstructive sleep apnea (OSA) the body stops breathing during sleep. The most common reason for OSA is swelling of the tissues at the back of the throat that then block the airway.

In central sleep apnea (CSA) is a breathing decreases or stops during sleep. It may occur as a result of a problem in the sleep centers in the brain, and/or the nerves supplying the heart. It usually follows a cycle, with people breathing normally for a while and then slowing or stopping altogether.

Continuous positive airway pressure (CPAP) that provides a steady stream of pressurized air is often the best treatment for sleep apnea.

There is a close relationship between breathing and the heart, and new research from the Alfred Hospital and Monash University in Melbourne, Australia has looked at a sleep-related breathing disorder that is common in heart failure, and increases HRV.

The researchers looked at the breathing patterns of 21 patients with heart failure who had sleep-related breathing disorder.

They found that as people transitioned from stable breathing to a sleep-related breathing disorder, there was an associated increase in HRV.

On the other hand, people with central sleep apnea (CSA) and obstructive sleep apnea (OSA) produce different patterns of HRV, suggesting that they each involve different mechanisms in the heart and the brain.

This may sound esoteric, but it is not.

Breathing problems during sleep are common and so is heart failure. Unfortunately heart failure carries a high mortality rate, and it is very valuable to have simple tests to guide us to give the correct treatment.

Simply measuring HRV during sleep will give us an idea about whether or not a person with heart failure is stable, or if we need to change treatments before he or she starts getting symptoms.

“All the energy that is used in the creation of every cell in the universe is on that breath that you are breathing in.”
--George King (English Spiritual Teacher, Writer and Founder of the Aetherius Society, 1919-1997)

“For breath is life, and if you breathe well you will live long on earth.”
--Sanskrit Proverb

“There is one human activity which is continuous, rhythmic, natural, easy, and pleasant. It is breathing. We may take advantage of its existence by combining it with a simple exercise to bring about a kind of meditation which will possess all these four mentioned attributes. The exercise is merely to repeat one word silently on the inhalation and another word on the exhalation. The two words must be such that they join together to make a suitable spiritual phrase or name. Here is one useful example: "God Is.”
--Paul Brunton (a.k.a. Raphael Hurst, English Philosopher, Traveler, Spiritual Teacher and Author, 1898-1981)

“You know that our breathing is the inhaling and exhaling of air.  The organ that serves for this is the lungs that lie round the heart, so that the air passing through them thereby envelops the heart.  Thus breathing is a natural way to the heart.  And so, having collected your mind within you, lead it into the channel of breathing through which air reaches the heart and, together with this inhaled air, force your mind to descend into the heart and to remain there.”
-- Nicephorus the Solitary (Calabrian Christian Mystic and Monk on Mount Athos, c.1250-1300)

Minocycline and Neurological Disease

We recently talked about the fascinating new data on the use of the antibiotic minocycline for treating stroke. The reason is that minocycline is also an anti-inflammatory and it also prevents “apoptosis” or programmed cell death. It has been found to be neuroprotective in animal models of stroke, traumatic brain injury and neurodegenerative disorders. Minocycline also prolongs survival and reduces the loss of motor neurons in transgenic mouse models of amyotrophic lateral sclerosis (ALS), a.k.a. motor neuron disease, a.k.a. Lou Gehrig's disease.

But as with any new research, we always have to go back and re-check and replicate everything. How many times have you heard a news item about some major breakthrough, and then you never again hear anything about it?

An article in today’s issue of the Lancet has indicated that minocycline may be harmful to people with ALS. This is important and will have implications for several clinical trials that are either planned or in progress for trying minocycline in people with dementia, stroke, Huntington's disease and multiple sclerosis.

The United States Western ALS Study Group based at Columbia University in New York, undertook a randomized phase III trial to test the efficacy of minocycline as a treatment for ALS in 412 patients. Patients who took minocycline deteriorated at a 25% faster rate compared with people on placebo.

Therefore the authors suggest that trials of minocycline in other neurological diseases should be reassessed. It is possible that minocycline might be detrimental in patients with other neurological diseases as well.

There is also an editorial comment by Mike Swash, who was once one of my teachers. He talks about the importance of early diagnosis in ALS:

"Clinicians and patients alike would prefer ALS therapy to be tested as early as possible, but there are unresolved difficulties with accurate early diagnosis, particularly the absence of a specific diagnostic test. Might some of the compounds that have failed in clinical trials show benefit if tested at disease onset in human beings?" He concludes that the time has come for new approaches to trial design: "The aim must be to design informative, short, inexpensive, and sensitive phase I/II studies before large phase III studies are attempted".

This is another one of those examples where a medicine introduced for one indication may have many others. In contrast to an antibiotic being used to treat neurological problems, there has recently also been a great deal of interest in the antibiotic potential of some medicines used to treat depression and psychosis.

There is a mountain of new information on this topic, which promises to revolutionize many of our concepts of health and disease. I shall keep you posted as more material is published.