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A Supplement to the Daily Record
2 MEDICAL DIRECTORY | 2009
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4 MEDICAL DIRECTORY | 2009
YOUTHFULNESS AN AMERICAN OBSESSION
— AT WHAT COST?
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2009 | MEDICAL DIRECTORY 5
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By MARTHA IRVINE
and LINDSEY TANNER
Associated Press Writers
LAS VEGAS (AP) — It’s one
of those photos that make you do a
Dr. Jeffry Life stands injeans, his
shirt off. His faceis that of adistinguished-
looking grandpa; his headis balding, and
what hair there is is white.
But his 69-year-old body looks
like it belongs to a muscle-bound
The photo regularly runs in ads
for the Cenegenics Medical Institute, a
LasVegas-basedclinic that specializes in
‘‘age management,’’ a growing field in a
society obsessedwithstaying young. Life,
who swears that’s his real last name, also
keeps a framed copy of the photo on his
office wall at Cenegenics.
‘‘He’s the man!’’ patient Ed
Detwiler says teasingly, pointing to the
photo of the doctor who, in many ways,
has become his role model.
Detwiler, 47, has been Life’s
patient for more than three years. In
that time, he has adopted the regimen
that his doctor also follows —drastically
changing his exercise and eating habits
and injecting himself each day with
weekly testosterone injections.
He does it because it makes
him feel better, more energetic,
He does it because he wants to
live a long, healthy life.
‘‘If I were stooped over and
bedridden, what kind of quality of life
is that?’’ asks Detwiler, a real estate
developer in suburban Las Vegas who
and your brain regularly are considered
tried-and-true tactics for staying young.
Protecting yourself from harmful sun
rays is another. Even flossing teeth is
a habit that, according to research on
people who live to 100, might extend
But that’s generally where the
Many in mainstream medicine
andelsewhere worry that we’re becoming
too focused on treatments with short-
term benefits that have potentially
dangerous side effects and scant, if any,
evidence that they’ll helpinthe long run.
Indoing so, they wonder if some people
are actually jeopardizing their chance at
a long, healthy life, both physically and
‘‘The quest tolive forever andthe
desire to avoid diseases and not suffer’’
is understandable, says S. Jay Olshansky,
a public health professor and longevity
researcher at the University of Illinois at
But it canmakepeoplevulnerable
to far-fetchedandpotentially dangerous
scams, he said, with some of the more
bizarre including fetal cell injections,
inhaling radon gas, even cutting off
testicles, an ancient practice meant to
reduce overexposure to reproductive
trying to sell to people what doesn’t yet
exist and they’re making gobs of money
doing it — much to the dismay of those
of us who are vigilant about protecting
public health,’’ he says.
There also are concerns that this
obsessionis sending the wrong message
to younger generations.
Surveys from cosmetic surgery
trade groups suggest that sizable
numbers of people, even in their 20s,
are getting cosmetic procedures.
And a fall 2007 survey from
TRU, a research firm that specializes in
the teenage demographic, found that a
says he’s doing this, in part, for his wife,
who is nine years younger. ‘‘If I can get
out and be active and travel and see the
world and be able to make a difference
in other people’s lives, then yes, I would
want to have as long an existence as
It is a common sentiment in a
society where many of us strive to look
and feel decades younger — to prove
to ourselves and the world that we are
healthier andmore vital thanour parents
were at our age. We’ve all heard it: 60 is
the new 50, the new 40 and so on.
But often, we need a little help.
Sometimes, a lot of help.
As the baby boomers march
toward retirement, Botox, wrinkle fillers
and hormones of various kinds have
become big business. Medco’s latest
drug trend report shows, for instance,
that human growth hormone use grew
almost 6 percent in 2007.
The list for age-defying tactics
is endless. Want six-pack abs? There’s a
surgical procedure to create fake ones.
How about drastically cutting your
calorie intake to slowthe aging process?
There’s a group of die-hards that swears
Thi s search f or et er nal
youthfulness certainly isn’t new. ‘‘In1,500
B.C. peoplewereingestingtiger gonads to
rejuvenate them,’’ says Dr. Gene Cohen,
a George Washington University expert
But for a generation of adults
who’ve been weaned on the modern
marketing message — that for a price,
you can have it all — the quest is taking
on a new urgency.
There is, of course, much to be
said for taking good care of yourself.
Eating healthy and exercising your body
quarter of young people, 12 to 19 —and
a third of girls in that age group — are
interested inhaving cosmetic surgery to
improve their appearance.
Michael Wood, vice president
and director of syndicated research at
TRU, was a bit startled by the results.
‘‘There’s no doubt that the
celebrationof youthandlooking younger
has certainly accelerated in the last 10
years, five years even,’’ Wood says. ‘‘And
this is a generationthat’s growing upwith
that at a very young age.’’
The effect has been palpable,
says Neil Howe, a respectedgenerational
expert whohas writtenextensively about
‘‘millennials,’’ young people who are
coming of age in this century.
‘‘I guess evenyoung isn’t enough
anymore,’’ Howe says. ‘‘It’s got to be
Alex Sabbag, a 23-year-old
Chicagoan, has felt the pressure, both
self-imposed and societal.
‘‘I’ll age until I’m 25. Then I’m
over it,’’ she said to co-workers during a
lunchroom conversation that turned to
the topic of Botox.
She was only partly serious. But
she says she’s also accepted that we
live in a society where being well put-
together and youthful gives you status.
‘‘We all buy into it,’’ Sabbag says.
And plastic surgery and other cosmetic
procedures are part of it.
She’s never had anything done,
thoughwouldn’t rule it out inthe future.
She also vividly recalls how her mother
left home for several days, whenSabbag
was in elementary school, and returned
after having a facelift.
‘‘I think it gives womenandmen
alike worlds of confidence that ultimately
makes thembetter people,’’ Sabbag says.
‘‘Yes, it is a vain practice ... but I think
there comes a point for people when
hardwork isn’t enoughto kick the last bit
of belly fat or gravity has become entirely
too unbeatable, and so a little nip-tuck
YOUTHFULNESS AN AMERICAN
OBSESSION — AT WHAT COST?
6 MEDICAL DIRECTORY | 2009
of the forehead needs to happen.’’
Detwiler, Life’s patient at
Cenegenics, is not looking for the
appearance of youth. He’s looking to
extend his youthfulness, and his life.
He knows about human growth
hormone andits controversies insports.
But this, he and his doctor insist, is
different. While it is illegal for these
kinds of hormones to be dispensed for
anti-aging purposes, he takes relatively
low doses prescribed for ‘‘hormone
deficiency.’’ The idea is to bring his levels
back up to those of a young man
in his 20s.
‘‘My friends say, ’Oh, Ed’s
on steroids,’’’ says Detwiler, who has
watched as muscle has replaced fat on
his belly and elsewhere. ‘‘No, I’m not.
Look at me. Do I look like
I’m on steroids?’’
He holds out his arms toindicate
that his body is fit-looking, but not
monstrous. ‘‘I’m not. I’m on hormone
therapy,’’ he says of a regimen that costs
him more than $1,000 a month.
Besi des human gr owt h
hormone, testosterone, and an adrenal
hormone known as DHEA, his diet now
largely consists of things like hard-
boiled eggs, fruits, nuts, Greek yogurt,
salads and palm-sized pieces of fish,
chickenor low-fat beef. He also exercises
regularly, alternating between intense
cardio workouts and weight-resistance
‘‘I can’t tell you in words how
great I feel,’’ says the man who used to
crack open a Pepsi to get him through
For a groupknownas the Calorie
Restriction Society, youthfulness isn’t
found in hormones. It’s reducing food
intake to, in some cases, near-
But the claims are much the
same — ‘‘lots of energy’’ and feeling
‘‘sharp,’’ says Brian Delaney, a 45-year-
old California-born writer now living
in Sweden. He’s the president of the
groupthat claims about 2,000 members
worldwide andmany more followers who
use the method in hopes of markedly
increasing their longevity.
By cutting daily calories to about
1,900, roughly half the recommended
amount for someone his height andage,
and exercising every day, Delaney has
shrunk himself to about 140 pounds.
He says his blood pressure, cholesterol
and blood sugar levels have improved
At 5 foot 11, he admits he’s
‘‘scrawny,’’ which he calls the
say the least, says Dr. Jonathan Lippitz.
He’s an emergency room physician in
suburban Chicago who does cosmetic
procedures, such as Botox and skin
fillers, in a separate practice.
But it’s also a ‘‘very slippery
slope,’’ with patients sometimes willing
to take more risk than they should and
some doctors who’ll accommodate.
‘‘They’ll always find somebody
willing to do it,’’ he says.
In his own practice, he says he
finds himself continually walking a fine
line in deciding which procedures he’ll
do — and which ones he won’t.
‘‘We all say, ’I want my hair
different. I want my eyes different,’’’
Lippitz says. ‘‘This idea of being perfect
is a problem, though, because it’s not
‘‘I have people coming in and
saying ’I want these lips.’ I say, ’Youcan’t
have these lips.’
‘‘I say, ’We’ll work withwhat you
But what if what they have is just
fine? These are the sorts of questions that
trouble Dr. Michael Morgan, a dentist
who does cosmetic work in another
He’s been seeing more young,
female clients walking throughhis doors.
And even his own 13-year-old daughter
asked if he would whiten her teeth,
something he didn’t think she needed.
Nor did he consider it safe for her young
teeth or ‘‘age appropriate.’’
‘‘There’s a consciousness about
it. They are much more concerned with
the appearance of their face. But there’s
also a social pressure,’’ he says of the
younger generation for whom he’ll do
the most conservative procedures, but
He sounds a little sad when he
talks about it.
‘‘There’s nothing wrong with
wanting to look better. We want to look
young. We want to look great,’’ he says.
‘‘But part of that feeling has tocome from
For those going to even greater
lengths to try to keep aging — and
ultimately death — at bay, there also
are no guarantees.
Calorie restriction guru Dr. Roy
Walford succumbed to complications
fromLouGehrig’s diseaseat age79, closer
to the average than the ‘‘extraordinarily
long life’’ his followers talk about ontheir
Meanwhile, Dr. Alan Mintz,
founder of Cenegenics, died at the
relatively young age of 69 due to
complications during a brain biopsy.
to stay warm—because of little body fat
or, he claims, an effect of slowed aging
— are barely annoyances for Delaney.
He says he eats sensibly,
replacing junk food with lots of fruits
and vegetables, no meat, and two meals
daily — no lunch. Breakfast is often ‘‘a
hearty bowl’’ of granola, with fruit, nuts
andsoy milk; while dinner couldbe fish,
rice, beans, a large salad and red wine.
Other than‘‘tons of fine wrinkles’’
he blames on too much sun as a kid,
Delaney says in most respects, ‘‘I look
much younger’’ than 45.
It is a bragging right many
‘‘ When we were younger,
we’d talk about someone who was 60
and that was old. And now my gym is
full of women over 60 and they look
phenomenal,’’ says Renee Young, a
48-year-old businesswoman in New
Rochelle, N.Y. ‘‘They don’t want to be
categorized as old.’’
But there’s more to it than that.
Youthfulness, she says frankly, is also a
means of survival inthe business world,
including in her line of work, public
‘‘It feels like you’re put out to
pasture. No one wants to feel that how
they look means that their ability to
do anything is decreased,’’ Young says.
‘‘If you have a younger look, you feel
healthier. You feel that you’re still in
Inthe back of her mindis the fact
that her ownmother died whenshe was
So five or six mornings a week,
even when she’d rather pull the covers
over her head, Young gets up and puts
in two hours at the gym.
That’s more than double the
hour or so a day generally recommended
for optimal health. And still, for her, that
wasn’t enough. She recently spent nearly
$20,000 on a tummy tuck because, as
she puts it, no number of abdominal
crunches was going to make her as trim
as she wanted to be.
The result has been a makeover
for her entire sense of self, she says.
‘‘I made a commitment this
summer. If I was going to go through all
this surgery, then it was going to have
to be part of a complete program,’’ says
Young, who’s also getting more rest and
‘‘I can definitely see the result.’’
She, too, says she has not felt this good
Using a cosmetic procedure as a
motivator is worthwhile, andlucrative, to
human growth hormone injections can
cause cancer. They’ve also been linked
withnerve pain, elevatedcholesterol and
increased risks for diabetes.
Even so, Life, now the chief
medical officer at Cenegenics, remains
steadfast. Among other things, he points
tostudies that suggest that humangrowth
hormone in low doses poses no cancer
risk if there is no preexisting cancer.
‘‘Withinthe next 10 years, maybe
less, this is going to be thought of as
mainstream medicine — preventing
disease, slowing the aging process down,
preventing people from losing their
ability to take care of themselves when
they get older and ending up in nursing
homes,’’ Life says. ‘‘This is really the
cutting edge of medicine.’’
Detwiler is betting on that.
I’mcheating God’s way. I don’t know,’’ he
says. ‘‘But I don’t want to regress. Why
He says his overall body fat has
dropped from nearly 17 percent to less
than 10 percent. He can’t remember the
last time he had a cold or the flu. And he
says he’s had the stamina to work long
hours, putting himonpace to earnmore
than a million dollars this year.
That’s what he knows now. The
future, he says, will be anyone’s guess.
‘‘People might ask, ’Hey, what’s
happenedto these people?Was it cutting
edge? Or did it cut it short?’’’ he says, as
he walks into a gym for
‘‘I think only time will tell.’’
On the Net:
• Calorie Restriction Society:
• Life Expectency Calculator:
• National Institute on Aging:
Martha Irvine is an AP national
writer. Lindsey Tanner is an AP medical
writer. They can be reached via
mirvine(at)ap.org or http://myspace.
2009 | MEDICAL DIRECTORY 7
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able to walk into a drugstore or health
foodoutlet andbuy a host of “probiotics”
— natural dietary supplements such as
Acidophilus or Lactinex — off the shelf
to treat conditions such as children’s
eczema or traveler’s diarrhea.
Unlike antibiotics, these self-help
products don’t kill germs, but they
supposedly confer health benefits, the
way vitamins and certain minerals do.
Existing probiotics haven’t beenapproved
He saidhis laboratory hadengineereda
newgenerationof “designer probiotics,”
which are tailored to target certain
disease-causing microbes or toxins. His
“goodbugs” mimic receptor proteins on
the surface of harmful bacteria andblock
their ability to infect healthy cells.
“Desi gner probi oti cs bi nd to
bacterial toxins in the gut ... thereby
preventing disease,” Adrienne andJames
Paton,researchers at the University of
Adelaide, Australia, reported in the
journal Nature Microbiology.
In a e-mail, James Paton said his lab
had designed a probiotic that works
against E. coli O157, a notorious microbe
that’s caused serious, sometimes fatal,
outbreaks of intestinal disease.
The needfor more effective antibiotics
is widely recognized because of an
alarming increase in the ability of
bacteria to resist standard medicines.
A special concern is the virulent MRSA
— methicillin-resistant staphylococcus
aureus — a bacterium that infects and
sometimes kills hospital patients.
“It i s becomi ng i ncreasi ngl y
apparent that alternative approaches
to conventional antibiotic therapy are
requiredtocontrol infectious diseases in
humans andanimals inthe 21st century,”
“Increasing incidence of antibiotic
resistance ... has forced clinical research
to explore alternative therapeutic and
by the Food and Drug Administration
or subjected to rigorous clinical trials.
Whentested, their effectiveness has been
mixed, medical researchers say.
Now, scientists are trying to design
“good bugs,” novel forms of bacteria
created in the laboratory to prevent or
cure specific diseases, including HIV
“Perhaps the only hope of winning the
war against ‘bad bugs’ will be achieved
by recruiting ‘good bugs’ as our allies,”
e-mailed Roy Sleator, a microbiologist
at University College in Cork, Ireland.
Sleator is the editor of a forthcoming
scientific journal called
prophylactic avenues,” Sleator wrote
in a British microbiological journal.
“Probiotics are finally beginning to
Sleator said his laboratory had
genetically engineereda harmless strain
of E. coli tosecrete a substance that might
be useful against HIV. He’s also working
on probiotics that may assist in the
prevention and decreased recurrence of
Researchers caution that designer
probiotics are still under development,
need further testing and government
approval, and suffer a number of
The “good bugs” are fragile and short-
lived, Sleator said, and scientists don’t
understand very well howthey work.
Paton said there was also “substantial
public mistrust” of genetically modified
organisms, such as good bugs, “which
may leadtomarketplace resistance even
to potentially lifesaving products.”
Nevertheless, scientists have faith
that designer probiotics eventually will
SCIENTISTS CREATE ‘GOOD
BUGS’ TO FIGHT ‘BAD BUGS’
8 MEDICAL DIRECTORY | 2009
By Robert Mitchum
wonder: a titanium femur.
The metal bone won’t give Johnson,
a salesman from Princeton in north-
central Illinois, the ability to kick down
steel doors or leap buildings in a single
bound. But his doctors said total femur-
replacement surgery, a procedure
performed less than 100 times a year
in the United States, should keep him
fromhaving to use a wheelchair for the
rest of his life or potentially having his
Twenty days after Johnson’s surgeons
performed the replacement, they
showed their tired but optimistic
patient the kind of shiny device that
has replaced the longest bone in his
body, as well as his hip and knee.
“No wonder I gained weight,” Johnson
said with a laugh as he marveled at
the construction of the artificial bone,
which actually weighs about the same
as the femur doctors removed this
The total femur replacement was
a “last resort” for Johnson, said his
surgeons, Dr. Henry Finn and Dr. Kris
Alden of the University of Chicago
Bone and Joint Replacement Center
Johnson’s femur was broken during
surgery to repair his 10-year-old
artificial hip this year, leading to a long
series of painful surgeries and difficult
rehabilitation to repair the frail bone. As
many as 20 screws and two metal plates
were implanted to support it.
In September, Johnson’s leg gave way
yet again in aWal-Mart parking lot, and
Shuffling through his physical therapy
exercises at Weiss Memorial Hospital
last week, 81-year-old Gene Johnson
did not appear particularly bionic to
the casual observer. But beneath the
complicated brace on his right leg was
a newly implanted device that sounds
more like science fiction than medical
surgeons said further reconstructive
surgery likely would be futile.
“If nothing were done, this man would
have to drag a painful leg around that he
could not walk on,” Finn said.
Though the replacement procedure
has been around for more than 40 years,
it is more typically used in patients who
suffer from rare bone cancers, said
Dr. Santiago Toledo, medical director
of orthopedic rehabilitation at the
Rehabilitation Institute of Chicago.
The surgery is rare in part because
its demands are so complex. Johnson’s
procedure took Finn and Alden more
than five hours because of the delicate
architecture of muscles, blood vessels
and nerves surrounding the femur.
Artificial femurs also can bring concerns
over durability and infection, doctors
A titanium femur costs more than
$20,000 in surgery, hospital care and
physical therapy. But Finn said the
cost is minuscule given the potential
benefits to patients like Johnson in
quality of life.
“You pay $80,000 for a Lexus, so what’s
a leg worth?” Finn said.
Alden and Finn predicted a slow
increase in the number of femur
replacements as life expectancy
“People are living longer and they
have more expectations on what their
golden years are going to be like,” Alden
Testing out his new femur by huffing
and puffing up and down three stairs,
Johnson said he had a humble goal
for his restored mobility: returning to
Princeton and walking—slowly—to
the bleachers of Bureau Valley High
School to watch volleyball and football
“It’s an unknown; there aren’t a lot of
people around to talk to about this,”
Johnson said of the titaniumbone. “But
hopefully it’ll let me live longer and do
MAN, HIS DOCTORS
SAY TITANIUM FEMUR
IS SPACE-AGE FIX FOR
METAL BONE CALLED
1ST STEP IN BETTER LIFE
2009 | MEDICAL DIRECTORY 9
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By Erin Richards
Milwaukee Journal Sentinel
One M&M, swallowedwhole, andlittle
Noelle’s skin turned as red as a Cortland
A month later, after eating soy ice
cream, the 2-year-old turned colors
again and started drooling, prompting
her mother to inject a syringe full of
epinephrine into the child’s leg.
KarenTylicki of Mukwonagohas noidea
why her daughter’s body treats certain
foods as if they were poison. Tylicki, like
parents of a growing number of food-
allergic kids inMilwaukee andelsewhere
around the country, is familiar with the
fear, uncertainty, grief and sorrow that
frequently accompany the condition.
Add hope to that list. Thanks to a
La Crosse clinic that’s gaining attention
for its work desensitizing patients with
food allergies, Noelle, now 6, can ingest
almost 2 ounces of milk without a
The spike in the number of kids
with food allergies - an 18% increase
nationwide over the past decade,
according toa newly releasedstudy from
the U.S. Centers for Disease Control and
Prevention- has promptedmany schools
and day-care facilities to develop new
At the Children’s Community Center,
a day care facility in Menomonee Falls,
director Nancy Larson said the jars of
peanut butter that were once standard
in every classroom have been removed
TaraWilliams, of the village of Belgium
inOzaukee County, saidher family went
through a period of mourning when
her then 11-month-old son, Brett,
was diagnosed with allergies to eggs,
dairy, peanuts, tree nuts, sunflower and
“Youstart thinking of all the kidthings
you envisioned doing as they grew up
- going out for pizza, ice cream on a hot
summer night, even just having them
leave your eyesight without worrying,”
Williams said. “You go through anger
andsadness. Everything will be fine for a
while, and then he’ll have a reaction out
of the blue, and you’re all upset about it
Theories abound about why more
children are suddenly allergic to more
foods. Michael Zacharisen, a physicianin
the Allergy/Asthma/Immunology Clinic
at Children’s Hospital of Wisconsin in
Wauwatosa, saidnoneof them- the“we’re
too sanitized” theory, the “antibiotics
leaching in the gut theory,” for example
- has been proved.
“Food allergy has lagged a bit behind
other research because it doesn’t have
pharmaceutical funding,” Zacharisen
Research on potential treatments is
because of the increase in peanut
“If someone forgot their lunch, we
always used to give them peanut butter
and crackers,” Larson said. “Now we
purchase soy butter.”
In Waukesha Public Schools, District
Nurse Twyla Lato said schools aren’t
“peanut-free” because that gives children
a false sense of security. Nevertheless, the
number of kids in the district with food
allergies is startling: 545 students last
year, compared with 481 in 2003-’04.
At Grafton Elementary School,
Principal Jeff Martyka said that five
years ago he didn’t have any students
“on epinephrine,” the adrenaline-like
drug that severely allergic children are
supposedtocarry withthemat all times.
Nowhe has seven.
Jamie Dempsey, 6, is one of them.
Although he brings his lunch to school,
his allergies to milk, eggs, peanuts and
sesame are so severe that he eats on
a sanitized lunch tray to avoid getting
any of the offending substances on his
skin. In the classroom, Dempsey and
his classmates have hand sanitizers on
“It’s hard - trying to strike a balance
between providing awareness and not
provoking anxiety in people or coming
across as a high-maintenance mom,” said
Monica Dempsey, Jamie’s mother.
Food, emotions linked
Foodandemotions are sointrinsically
linked that dealing with the pitfalls of
food allergies can seem like a disability
at times, parents say.
more promising. At Duke University,
subjects in a study are being given tiny
amounts of liquid or powder peanut
protein to see if they can build up a
tolerance over time.
Allergy Associates of La Crosse has also
championedthe practice. The clinic sees
more than 10,000 patients a year who
come for “sublingual immunotherapy” -
or the placing of tiny drops of the allergen
under the tongue to stimulate the oral
mucosa. According tothe clinic, 43 states
are using the La Crosse method to treat
patients with food and other allergies.
Mary Morris, the clinic’s lead allergist,
saidthe goal is tominimize the effects of
an accidental exposure.
Patient Noelle Tylicki, who started
kindergartenthis year inGenesee Depot,
will increase her dosage of milk one last
time in January. She has completed the
desensitizing programfor eggs.
“I have togive her wings at some point,”
her mother said. “She has tobe able tofly
FOOD ALLERGIES ON RISE IN
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SEATTLE - The Uni versi ty of
Washington has been awarded a five-
Medicine and will focus on multiple
sclerosis, spinal cord injury, muscular
dystrophy and post-polio syndrome.
“Although much research has been
done on these disabling conditions,
very little has been done on the effect
of aging in compounding the functional
problems of persons with these four
disabilities,” says Dr. George Kraft, a
University of Washingtonphysiatrist and
Alvord Professor of MS Research. “This
center will be the first to explore these
important research questions.”
The grant was awarded by the National
Institute onDisability and Rehabilitation
K. Warner Schaie agreed to present
findings from his exhaustive study on
aging at last year’s Washington State
Psychology Association conference, but
only if he could bring 26 guests. They
ranged from74 to 101 years old and had
stuck with him for a half-century.
They were a handful of the 500 subjects
who enrolled in the first year of the
Seattle Longitudinal Study in 1956. Still
going, it is considered by many to be the
most extensive and lasting psychological
research study on how people develop
and change cognitively as they age.
Information from it has helped change
mandatory-retirement lawand combat
phrases like “having a senior moment”
year, $4.5 million grant to research
specific challenges related to aging with
The Aging Rehabilitation Research
and Training Center will be based in
the University of Washington Medical
Center’s Department of Rehabilitation
and other examples of ageism.
Schaie, whois 80, has publishedbooks,
monographs, chapters and papers
and testified before Congress about
age discrimination in the workplace.
But recalling the day he presented
his information alongside the people
instrumental in building the database
makes him smile.
“One of my subjects, a 101-year-
old woman, sat in the front row,” he
says. “And she was scribbling all these
A LONGTERM STUDY
Every sevenyears, Schaie and his team
have tested and added people to the
study. About 6,000 people, insome cases
representing three generations of the
same family, have been tested at least
The st udy exami nes heal t h,
demographi c, personal i t y and
environmental factors that influence
individual differences. Subjects take
cognitive tests and answer psychological
questions while researchers try to learn
why some people stay sharp well into
old age while others falter.
In recent years, investigators have
drawn blood samples and administered
brainscans to add neurological evidence
to the database, some of which might
one day be relevant to the early detection
STUDY ON AGING STILL
GOING STRONG SOME 50
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Psychologist Alejandra Suarez, who
teaches at Seattle’s Antioch University,
says following the progress of the same
set of subjects for so long has made
Schaie’s study especially valuable.
“Many studies about how people
change cognitively are done by asking
people of different ages to participate
in the studies - which is like taking a
snapshot of how different generations
function intellectually at a single
moment in time. But those results are
misleading because the differences
can be due to changes in education,
nutrition and diversity of opportunities
“What Dr. Schaie has done is
invite people to participate and then
interviewed and assessed them every
seven years, to see how a particular
person changes and evolves, compared
to his or her original abilities. This means
that he can rule out that the changes are
due to generational opportunities and
Continued on the next page.
While an undergraduate at the
University of California in 1951, Schaie
worked in the composing room of
the San Francisco Chronicle. Because
the newspaper was published in the
morning, he worked late into the night,
shrinking the range of classes he could
take and leading him to conduct an
adult development study as a way to get
His family doctor happened to have a
geriatric practice, too, andallowedSchaie
to survey willing patients. To Schaie’s
surprise, he was invited to present
findings fromhis studyat aninternational
geriatrics conference inSt. Louis. He got
there by Greyhoundbus andmet some of
the leaders inthe small but growing field.
When he was accepted into graduate
school at the University of Washington,
he chose, as his niche, gerontology.
“People would say who is this crazy
young guy interested in old people,”
he says, laughing. “Why doesn’t he
do something ‘mainstream?’ It wasn’t
He got his initial sample (and every
subject since) for the Seattle Longitudinal
Study from Group Health Cooperative.
He left Seattle upon graduation but
continued to return to retest and add
more tothe study. Eventually he openeda
permanent office here andbegantesting
his subjects’ offspring. The work is funded
by the National Institute on Aging.
80 ANDSTILL GOING
Having just retired from Penn State
University, Schaie and his wife, fellow
scientist Sherry Willis, moved back to
Seattle. Willis has been co-investigator
on the study since 1983.
The subjects alsohave helpedscientists
learn about whether people can recover
mental function through intensive
trainingsessions. That sort of workhelped
inspire the “brain fitness” software and
books that flood the market today even
thoughSchaiebelieves someof theclaims
behindthose products have not yet been
fully validated through research.
Along the way, he has studied howlife
events, fromlosing a spouse torecovering
from cancer, affect a person’s cognitive
ability and has searched the data for
nuances. There are all sorts of factors that
can hasten decline, but Schaie has also
seen cases where scores improve, such
as when a cancer treatment has been
successfully completed or someone has
come to terms with a spouse’s death.
“How you live your life makes a
difference as to how you will move into
old age,” he says. “You don’t suddenly
become a member of a difference species
whenyougrowold. It’s clear that a person
who is quick-minded and not rigid in
his thinking has an advantage. Things
change, but if you’re a good problem
solver or successfully handleda personal
crisis when you were younger you will
likely continue to do so.”
He also believes that education and
continuingcuriosity may protect aperson
from rapid decline. Why does he, at 80,
still collect and interpret the data?
“I really don’t have any compelling
hobbies that challenge me,” Schaie says.
“I findthis stimulating, my work is still in
demand to a degree and I get to remain
intouchwithmy colleagues, whoare also
my friends - and that’s important, too.”
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2009 | MEDICAL DIRECTORY 13
By Don Sapatkin
The Philadelphia Inquirer
PHILADELPHIA - In the late 1700s,
Italian anatomist Luigi Galvani made a
dead frog’s muscles twitch when struck
by a spark, a discovery that paved the
way for the modern understanding of
electricity’s role in living things. It is the
basis for countless medical technologies
like the pacemaker.
But electricity does not travel easily
through the skull to the brain, the organ
responsible for every purposeful twitch
and altered mood. So when a group of
British scientists in 1985 used magnetic
pulses from outside the head to induce
an electrical field inside the brain - and
got a subject’s hands to move - their
colleagues clamored for a chance to zap
That breakthrough, known as
approval last month of the first
treatment for depression.
As a practical matter, approval of
the device made by Neuronetics Inc.,
a five-year-old Malvern, Pa., company,
is intended for patients with major
Ernie Mercer in the late 1980s, Prozac
had just come on the market, and it
worked. When depression struck again
five years ago, it didn’t. Neither did
Effexor or a third drug. Worse, they made
him nervous and constipated.
For Mercer, a retired engineer who
lives near Atlantic City, depression was
withdrawal from life. “Nothing was fun
anymore,” he said.
He answered an ad seeking research
volunteers for anexperimental treatment
The clinical trial of transcranial
magnetic stimulationwent like this: He’d
showup at a University of Pennsylvania
clinic five times a week, answer the same
set of questions about his mood, and
then sit in what resembled a dentist’s
chair for 40 minutes with earplugs in
his ears and an apparatus strapped to
the top left of his head. He heard loud
clicking sounds but felt nothing.
After four weeks, a sensationsuddenly
matched the clicking - “kind of like
somebody tapping on your scalp like
10 times a second,” he said - and his
depression began to lift. He had been
initially assigned to the sham(placebo)
group; now he was getting TMS. After
several weeks of the real thing, he felt
fine. He still does.
Mercer, 65, paid nothing for either
treatment-resistant depression who
do not respond to any one medication.
Millions of Americans fail to benefit from
antidepressants, and millions more quit
because of side effects.
Symbolically, the federal action is a
big deal - another advance in a group
of emerging fields that involve electrical
stimulation of the brain.
“Our view of the brain is changing,”
said Mark S. George, a professor of
psychiatry, radiology and neuroscience
at the Medical University of South
Just 10 or 15 years ago, scientists
thought of the brain as a single entity
- what he called “the brain-as-soup”
model. “But really you want to treat
specific regions in the brain.”
George is editor in chief of a year-old
journal named Brain Stimulation, and
he is a champion for the cause. After
decades of success with psychiatric
drugs, he said, “we had forgottenthat the
brain is really an electrical organ.”
Researchers worldwide are testing
therapies ranging from highly invasive
electrical implants to hardly noticeable
magnetic fields ondozens of psychiatric
and neurological disorders. Success
has been limited - but so are current
When a major depression enveloped
the treatment series or twice-monthly
maintenance sessions ever since. The
researchgrant ends this month, however,
and the clinic will charge him$150 onits
sliding scale if health insurance doesn’t
cover it; most of the clinic’s patients are
likely to pay at least $200. Insurers are
just now beginning a review.
The new treatment is not a panacea.
An unrelated study two years ago found
that, of patients who failed to benefit
from one antidepressant medication,
just one-third responded adequately
to a second. TMS produced a similar
response rate (as does talk therapy,
according to other studies), although
the effect was described as greater.
The biggest difference is side effects,
which cause many patients to stop
taking antidepressants. The most
commonly reported side effects to the
brain stimulation were headaches and
scalp irritation, both temporary.
TMS poses a slight risk of seizure.
No incidents were reported in data on
10,000 sessions submitted to the FDA.
Neuronetics didn’t seek approval
to treat all major depression; when
antidepressants work well, they are
hard to beat. Still, the FDA rejected the
initial application last year to use the
NeuroStar TMS device for treatment-
resistant cases generally.
A reanalysis of data on the 301
patients in the multicenter trial found
the strongest response among those
who had tried and failed with just
one drug, and that’s what the agency
approved. Patients like Mercer, who gave
up on three, can be treated “off label,”
which may be less likely to qualify for
Oddly enough, Tufts University
psychiatrist Daniel Carlat said he would
be more likely to steer those patients -
the ones least likely to respond - toward
TMS because they’ve run out of easy
Carlat, who has no connection with
the manufacturer or drugmakers, has
written skeptically about TMS in past
issues of his Carlat Psychiatry Report.
He said the latest findings changed his
Psychiatrist John O’Reardon, who
ran the Neuronetics-funded trial at
Penn and is beginning to study TMS
for Attention Deficit Hyperactivity
Disorder in adolescents, believes
that many people who can’t tolerate
antidepressants will find this easier
despite the inconvenience of 20 to 30
“They come in and sit in the chair,
we slap a magnet on their head for 30
ELECTRICAL STIMULATION OF THE BRAIN A
BREAKTHROUGH IN TREATING DEPRESSION
14 MEDICAL DIRECTORY | 2009
Dr. Donald W. Orminski
307 S. 12th Ave, Suite 9
Yakima, WA 98902
509.248.4900 • 800.676.4675
minutes, and afterward they can go
home,” said O’Reardon, director of
Penn’s Treatment Resistant Depression
static magnets. The electromagnet in
the new device is thousands of times
more powerful, similar to that of anMRI,
said Neuronetics chief executive officer
In repetitive transcranial magnetic
stimulation (rTMS), rapid series of
pulses pass through the skull and induce
an electrical field on the surface of the
brain, exciting the neurons below.
For depression, the target is a postage
stamp-size part of the left prefrontal
cortex that is less active in depressed
people. Scans confirm more activity
after successful treatment of any kind,
although the exact mechanism is not
The therapy is being studied for post-
traumatic stress; obsessive-compulsive
and panic disorders; fibromyalgia; and
The most promising results are for
dampening the auditory hallucinations
that schizophrenics describe as hearing
voices. Ralph Hoffman, aYale psychiatry
professor who began studying the
treatment 10 years ago, said the latest
data showed “a significant effect,”
although years away from clinical use.
It is the repetition in rTMS that
seems to retrain the neurons and bring
enduring change. Single-pulses, called
sTMS, have a short-term effect.
Neuralieve Inc., of Sunnyvale, Calif.,
has applied for FDA approval of its
portable, handheld sTMS device for
the one-third of migraines that are
preceded by recognizable visual or
sensory symptoms known as auras.
The battery-operated device is about
the size of a hair dryer. At the onset of
symptoms, you place it against the back
of your head and press a button. After
30 seconds to recharge the batteries,
you deliver a second pulse. The short-
termstimulation disrupts the spread of
abnormal brain waves.
It left nearly 40 percent of participants
in a recent clinical trial pain-free after
two hours, said Terese M. Baker, the
company’s vice president of marketing.
“You can stop the migraine progression
before it takes root,” she said.
The oldest form of brain stimulation,
dating to the 1930s, is electroconvulsive
therapy. It is the most effective treatment
for major depression. Once stigmatized
as “electroshock,” ECT has been refined
in recent years. But it works by causing
seizures, and the risk of serious side
effects, especially memory loss, still
limits its use to the most serious cases.
A kinder, gentler version may be in
the works. Sarah H. Lisanby, a professor
of clinical psychiatry at Columbia
Magnet t herapi es have been
advertised for years, usually to relieve
pain, but have not been proved to work
in rigorous trials. Most rely on simple,
University, developed magnetic seizure
therapy (MST), which uses magnetic
pulses to induce seizures.
“With magnetic fields, we have better
control,” she said. The seizures are more
focused and less robust.
Lisanby, who is researching several
types of brain stimulation, thinks that
part of the potential of these fields lies
in the ability to tailor treatments for an
individual. Magnetic and electrical fields
canbe aimed at a variable target. Today’s
drugs cannot be.
Anthony T. Barker has been following
all these developments with interest
from afar. Barker led the team that
zapped a man’s brain with a magnetic
pulse in 1985 and got his hand to move.
And while none of the newtherapies was
on his radar screen at the time, so many
colleagues wanted to“have a go” that he
knew something would come of it.
“It is arguably one of the coolest
demonstrations of physics’ effect on the
human body,” said Barker, a professor in
medical physics and clinical engineering
at Royal Hal l amshi re Hospi tal ,
“If you were here, I would zap your
brain and make your hand move, and
you would think it was cool, too.”
Brain Stimulation Therapies
At least nine methods are being
The most common:
_Transcranial magnetic stimulation
With the patient awake in the office,
external magnetic pulses induce an
electrical field on the surface of the
brain, activating neurons below.
_Electroconvulsive therapy (ECT)
Electrical stimulation of the scalp
under anesthesia induces a wave of
activity across the brain - a seizure. A
gentler, magnetically triggered version
is being tested.
_Vegus nerve stimulation (VNS)
A pacemaker in the chest sends
electrical impulses to electrodes in
contact with the vagus nerve in the
neck, and then up to the brain.
_Deep brain stimulation (DBS)
This is similar to VNS, but electrodes
are surgically implanted in the brain
to stimulate precise regions in various
disorders. Highly invasive.
2009 | MEDICAL DIRECTORY 15
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PHILADELPHIA - Diabetes has cost
Robert Heard dearly. His left leg was
amputated below the knee two years
ago. Kidney failure - with its special
diets, thrice-weekly dialysis, and ever-
present threats of infection - is worse.
“It breaks you down mentally,” says
Heard, 32, who has been waiting for
a second kidney transplant since the
first, donated by his uncle, failed four
problems or heart disease often come to
mind. That’s a correct association, but so
is kidney failure.
The number of Americans diagnosed
with the condition increased five times
over the past three decades, a period that
also sawa staggering rise in the number
of Americans with diabetes.
Nearly half of all kidney failures in this
country are now caused primarily by
diabetes, according to a leading federal
“The link is incredibly powerful,”
says Richard C. Wender, professor of
Heard was diagnosed with Type 1
diabetes at age 10, and said he managed
it well for 15 years until, as an adult,
he changed jobs and lost his health
insurance. Unable to get the medicines
he needed, the Logan resident lost
control of his blood sugar levels.
chronic illness, Heard regularly ended
up in the emergency room. And like
more and more diabetics, his kidneys
finally gave up.
Ask someone about diabetes, and eye
medicine at Jefferson Medical College
in Philadelphia. “Diabetes is the leading
cause of kidney failure in the U.S.”
The United States spends $34 billion
a year on kidney failure. And the bulk,
more than $20 billion a year, is covered
by taxpayers through Medicare.
About 24 million people nationwide
have diabetes, federal authorities say,
and 57 million more are prediabetic -
with elevated blood sugar levels that put
them at high risk for the illness.
That means 81 million people, about
one in four Americans, are either
diabetics or potential ones.
For doctors, patients andpolicymakers,
the health-care system’s inability to
stop preventable kidney damage from
diabetes is frustrating. With good
primary care, diabetes can usually be
managed, or even spotted and stopped
before it fully develops.
But the system doesn’t pay well for
preventive care. Many patients aren’t
educated on how to manage their
conditions. Drugs canbe expensive, and
many people lack good access to care.
Even those who see their doctors
regularly could get in trouble because
good diabetes care takes time, a
commodity that few caregivers have
Kidney failure can be caused by either
major form of diabetes: Type 1, once
known as juvenile onset, arises from
the body’s inability to make insulin, a
key hormone that regulates the body’s
blood sugar levels.
Type 2, the more common, can
develop at any age, and is caused by
the body’s failure to use insulin. Bothcan
damage the kidneys and cause death if
Each kidney is essentially a giant filter
made up of roughly 1 million smaller
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filters known as glomeruli. These tufts
of tiny vessels remove waste, but not
nutrients, from blood.
Over many years, the excess sugar of
diabetes harms the membranes of those
vessels. An early sign of kidney disease
is the appearance of tiny amounts of the
protein albumin in the urine.
“If the filter is not working, you can
lose a lot of the good stuff into your
urine,” says Mitchell A. Lazar, director of
the University of Pennsylvania’s Institute
for Diabetes, Obesity and Metabolism.
At the same time, waste products and
excess fluids buildupinthe bloodstream.
So patients must get their blood cleaned
One way to accomplish this is to plug
into a mechanical kidney.
Catheters are placed into vessels in
the arm, enabling large amounts of
the patient’s blood to pass through
the machine’s filter and back into the
Patients must undergo this treatment,
called hemodialysis, for at least several
hours three times a week.
The treatment can cause many side
effects, ranging fromnausea and anemia
to infections and sudden drops in blood
pressure. Catheters also can become
clogged, requiring multiple procedures
to clear or make new openings
How can you avoid all this?
“The best strategy is to prevent
diabetes - and the most effective way in
the majority of patients,” said Jefferson’s
Wender, “is to maintain a normal weight
and exercise regularly.”
A better diet may help, including lots
of fruits and vegetables.
So can controlling high blood
pressure, a commonprecursor to kidney
Nearly everyone should get routine
blood tests to catch diabetes before it
damages the kidneys, said Jefferson
endocrinologist Serge Jabbour.
It is not uncommon for people with
Type 2 diabetes to live with the disease
for five or 10 years before developing
symptoms that cause them to seek
treatment, Jabbour said. During that
time, high blood sugar levels could be
damaging the kidneys.
If the worst happens and your kidneys
fail, a good attitude can still help.
“You need to stay happy, because the
more upbeat you are, the better things
go,” said Heard, who has gotten care at
Albert Einstein Medical Center in North
Philadelphia. The challenges of living
with the condition are “an everyday
thing,” he said.
Another patient, Ben Walters, 48, has
been controlling his blood sugar to keep
the disease from progressing.
Diagnosed with diabetes in 1990, the
Center City resident has since developed
diabetes-related nerve damage in his
right knee - a condition known as
Charcot’s joint - that severely limits
his ability to walk, forcing him to use a
Despite that and everything else -
getting dialysis three times a week that
often leaves himweary, and giving up a
job he loved as deputy inspector general
for the City of Philadelphia - Walters tries
to remain focused.
“I think I have extended my life,”
he said last month after four hours of
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RALEIGH, N.C. - WhenRachel Skergan
Instead, they would rely ontechnology
to allow her to hear and talk.
Rachel, now a chatty 5-year-old from
Raleigh, received a cochlear implant in
her left ear when she was 10 months
and another in her right ear when she
was 2½. Weekly therapy sessions helped
her interpret and reproduce sounds
the implants generated, and her family
took extra steps to improve her listening
But still missing was music.
Rachel could hear melodies and beats.
She could carry a tune, and she followed
the beat when she danced, her mother,
Natalie Skergan, said. Still, the details
of music were missing - the plinking
of piano keys, the rat-tat-tat of a drum
beat or the weeping of the strings in a
full orchestra at play.
To capture those details, Rachel has
become one of the first children in
this country to be fitted with the latest
cochlear technical upgrade: a speech
processor that promises to improve the
hearing of music.
The device was brought to market this
summer by a small Durham company
called Med-El. The privately owned
Austrian firm, which put its North
American headquarters in Durham
because of the scientific expertise in
theTriangle, is one of only three cochlear
was diagnosed with congenital deafness
shortly after she was born, her parents
made a choice that would alter her life:
She would not be taught to signwith her
hands or read lips.
implant manufacturers in the United
In the more than 20 years since the
Food and Drug Administrationapproved
the first cochlear implant, microchips
inside processors have gotten smaller
and more powerful. That has improved
the sound quality, but biomedical
engineers are still working to capture
the full range of musical sounds.
Med-El’s technology, like that of the
other manufacturers, digitizes the
sound that is picked up and sent to the
electrodes implanted in the patient’s
cochlea. Med-El claims its software
allows it to better fine-tune the signal
received by the patient.
Because music is such a complex
sound, research nowfocuses onsoftware
that would allowanaudiologist to better
program a processor to each person’s
hearing damage, said Charles Finley,
a biomedical engineer who teaches at
the University of North Carolina-Chapel
Hill and North Carolina State University.
Finley was part of a group of Triangle
researchers who in the mid-1980s came
up with the multiple-electrode design
that cochlear implants still follow.
“Every system has its limits,” Finley
said. “The same implant system can
do remarkably well in one person and
poorly in another.”
IMPROVE SOUND OF MUSIC FOR
18 MEDICAL DIRECTORY | 2009
Technological limitations are partly
why only half of the children who could
benefit from a cochlear implant have
one. Of about 38,500 Americans with
cochlear implants, 15,500 received them
as children, according to the most recent
figures from the National Institute on
Deafness and Other Communication
The hearing of deaf children develops
best with cochlear implants in place
early on. The longer the auditory nerve
isn’t stimulated, the more likely it is that
the brain uses nerve cells dedicated to
hearing for other purposes - a process
that is difficult or impossible to fully
reverse. The implications go beyond just
being able to talk and listen; the ability
to fully appreciate music has beenlinked
to better math skills.
Cost - an implant costs about $70,000
per ear including surgery - poor access to
audiology and auditory-verbal therapy
daughter’s first word three months after
the first cochlear implant was activated:
Rachel said, “Uh-oh,” whenshe dropped
something sitting in her high-chair.
Skergan doesn’t expect changes that
memorable from the newest processor
upgrade. But “I expect changes,” she said.
“I hope she’ll say, ‘This sounds better.’ I
expect music to be even better.”
The first session to program the
new processor, which included setting
sound levels on the 12 electrodes inside
Rachel’s ear, didn’t go well. Relying only
on the implant in her right ear, Rachel
picked up a blue crayon after being
asked to show a red one. Then Holly
Teagle, an audiologist and the UNC
clinic’s director, turned up the current
on all the electrodes simultaneously.
“Hey, too loud,” Rachel protested.
After Teagle had adjusted the current
to a more acceptable level, Rachel was
speaking loudly. “I can still hear,” she
services, and insufficient insurance
reimbursements are also to blame,
according to a paper published in April
in a peer-reviewed medical journal.
The Skergans, because of their
proximity to the same scientific expertise
that brought Med-El to the Triangle,
were able to overcome many of the
barriers to cochlear implants. Rachel’s
surgeon, audiologist andauditory-verbal
therapist are all in the Triangle, as is the
manufacturer of all her implants.
The new Med-El processor Rachel
received in August was part of an
upgrade that the Skergans chose at
the time of Rachel’s surgery in 2006. To
turn on the new processor - a thumb-
size device that hooks on the ear -
Rachel sat through more than 10 hours
of programming at UNC’s clinic for
children’s communicative diseases in
Natalie Skergan remembered her
said. “I can hear weird.”
A test in a sound booth confirmed
that more time would be needed to fine-
tune the processor’s program. Teagle
scheduled three more sessions, each
about three hours long. Shortly after the
programming sessions restarted three
weeks later, Rachel said she liked her
new processor better than the old one,
her mother said.
“She’s over the hump,” Teagle said
during the final session.
Like previous technological upgrades,
programming Rachel’s new processor
had taken time and effort. But Natalie
Skergan had no regrets.
“We’d do it again in a heartbeat,”
she said. “The gift to have her hearing
restored is priceless.”
2009 | MEDICAL DIRECTORY 19
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