Aging – Page 4 – artdiamondblog.com

With Repetitions Surgeons Gain Informal Knowledge, Such as “Muscle Memory”

(p. C6) Imagine you’ve been admitted to the hospital and you’re meeting the physician taking care of you for the first time. Who are you hoping walks through that door? Would you rather they be in their 50s with a good amount of gray hair, or in their 30s, just a few years out of residency?

In a study published in 2017, one of us (Dr. Jena) and colleagues set out to shed some light on the role of age when it came to internists who treat patients in hospitals. These physicians, called hospitalists, provide the majority of care for elderly patients hospitalized in the U.S. with some of the most common acute illnesses, such as serious infections, organ failure and cardiac problems.

. . .

. . ., the results suggested if the over-60 doctors took care of 1,000 patients, 13 patients who died in their care would have survived had they been cared for by the under-40 doctors. We repeated the analysis using 60- and 90-day mortality rates, in case longer term outcomes might have been different, but again, the pattern persisted: Younger doctors had better outcomes than their more experienced peers.

. . .

Younger doctors possess clinical knowledge that is more current. If older doctors haven’t kept up with the latest advances in research and technology, or if they aren’t following the latest guidelines, their care may not be as good as that of their younger peers.

. . .

. . ., a separate study by Dr. Jena and colleagues looked at about 900,000 Medicare patients who underwent common non-elective major surgeries (for example, emergency hip fracture repair or gall bladder surgery) performed by about 46,000 surgeons of varying age.

. . .

The results showed that unlike hospitalists, surgeons got better with age. Their patient mortality rates had modest but significant declines as they got older: mortality was 6.6% for surgeons under 40, 6.5% for surgeons age 40-49, 6.4% for surgeons age 50-59, and 6.3% for surgeons over age 60.

Clearly something different was happening here. It may be that for hospitalists, the benefit of steadily increasing experience starts to be outweighed by their waning knowledge of the most up-to-date care. It’s different for surgeons, though, who hone many of their skills in the OR. Surgeons build muscle memory through repetition, working in confined spaces with complex anatomy. They learn to anticipate technical problems before they happen and plan around them based on prior experience. Over time, they build greater technical skills across a wider variety of scenarios, learn how to best avoid complications, and choose better surgical strategies.

What does this mean for all of us as patients when we meet a new doctor? Taking studies of hospitalists and surgeons together, it’s clear that a doctor’s age isn’t something that can be dismissed out of hand—age does matter—but nor can it be considered in isolation. If we’re concerned about the quality of care we’re receiving, the questions worth asking aren’t “How old are you?” or even “How many years of experience do you have?” but rather “Do you have a lot of experience caring for patients in my situation?” or “What do you do to stay current with the research?”

For the full essay, see:

Anupam B. Jena and Christopher Worsham. “Do Younger or Older Doctors Get Better Results?” The Wall Street Journal (Saturday, July 8, 2023): C6.

(Note: ellipses added.)

(Note: the online version of the essay was updated July 8, 2023, and has the same title as the print version.)

The essay quoted above is adapted from the book:

Jena, Anupam B., and Christopher M. Worsham. Random Acts of Medicine: The Hidden Forces That Sway Doctors, Impact Patients, and Shape Our Health. New York: Doubleday, 2023.

The “Deliciously Guilty Pleasure” and “Disorienting Joy” of California Skiing in August

(p. A20) This weekend, . . . hordes of Californians are smearing pink and yellow zinc oxide on noses, shoving feet into hard plastic ski boots and gliding over to the lifts at Mammoth Mountain for yet another day on the slopes. A reminder: It’s August.

. . .

Unpredictable change is the new status quo. . . . it can also, in a rare instance like the chance to ski in the dog days of summer, bring a disorienting joy.

. . .

In mid-July [2023], well after all the hot dogs and fireworks, I headed up to the Sierra and ran into so much lingering snow that the road through Yosemite National Park hadn’t yet opened for the season. I took an alternate route, 108 over Sonora Pass, and saw people parking in turnouts, carrying skis up dirt trails through trees, stepping onto sunny snow slopes and linking turns back down to ice chests full of cold drinks before, you know, maybe going for a swim. When I finally got to Kelly’s place, the creek on her high desert property frothed in a fabulous white and clear torrent through sage lands sparkling with superblooming yellow mule’s ear, red paintbrush and white phlox. The big peaks, meanwhile — in the dead heat of a California summer — remained so heavily blanketed in snow that I felt I was seeing them the way Indigenous people must have during the Little Ice Age, 500 years ago.

The premise of California’s secular faith in nature is that water plus sunshine equals enlightenment. In high school I was transfixed by a description on the jacket of Bank Wright’s classic “Surfing California” of “skiing Mount Baldy in the morning and surfing Hermosa Beach in the afternoon.” That struck the teenage me as the absolute perfect way of snatching healthy peace and giddy fun from the predictable maw of adult misery.

. . .

. . . when I drove to Mammoth, put on my favorite cowboy hat against the sun and sipped iced coffee while watching tiny black figures ski down blinding white slopes, the experience was perhaps best likened to the queasy adrenalized thrill of an oncoming manic episode after a long and dark depression — worrisome, yes, bound for nowhere good but, as long as we’re just talking here and now, a deliciously guilty pleasure.

For the full commentary, see:

Daniel Duane. “The Upside of Climate Chaos? Skiing in August.” The New York Times (Monday, August 7, 2023): A20.

(Note: ellipses, and bracketed year, added.)

(Note: the online version of the commentary has the date Aug. 6, 2023, and has the title “It’s August. Californians Are Still Skiing. Don’t Ask.”)

Elderly Benefit Most from Air-Conditioning

(p. A18) The aging process makes older bodies generally less capable of withstanding extreme heat, doctors say.

“They’re at extremely high risk of heat stroke and death,” James H. Diaz, a professor of environmental and occupational health sciences at Louisiana State University’s School of Public Health, said of older people. “When we look at what happens with these heat waves, most of the deaths occur in the homebound elderly.”

In many communities, including in New Orleans and Houston, officials have opened cooling centers and shelters in recent weeks, with air-conditioned shuttle buses meandering through neighborhoods, picking people up. Programs are also in place to provide or repair air-conditioners or help people struggling to afford their electricity bills.

. . .

In . . . Orlando, Veronica King, 67, said she keeps her air-conditioner running even if she can’t afford to. “I have to figure out how to cover that bill,” she said, adding that she relies on machines that help her breathe. “When it’s hot, I can’t breathe.”

In Houston, where the heat index could reach 107 degrees on Sunday, Ms. Lowry and her husband, Jasper, 72, have come up with a compromise. They have two cars, neither with working air-conditioning. But they figured they could at least spare the money to repair it in one of them.

For the full story, see:

Shannon Sims and Rick Rojas. “Rising Temperatures Could Bring More Than Misery for Seniors.” The New York Times, First Section (Sunday, July 9, 2023): 18.

(note: ellipses added.)

(Note: the online version of the story was updated July 12, 2023, and has the title “Rising Temperatures Threaten More Than Misery for Oldest Americans.”)

Rage That Transplant Medicine Stagnates

The essay quoted below provides one more example of why we should unbind medical entrepreneurs to allow them to bring us more and faster cures.

(p. 8) Today, I will explain to my healthy transplanted heart why, in what may be a matter of days or weeks at best, she — well, we — will die.

. . .

Organ transplantation is mired in stagnant science and antiquated, imprecise medicine that fails patients and organ donors.

. . .

Over the last almost four decades a toxic triad of immunosuppressive medicines — calcineurin inhibitors, antimetabolites, steroids — has remained essentially the same with limited exceptions. These transplant drugs (which must be taken once or twice daily for life, since rejection is an ongoing risk and the immune system will always regard a donor organ as a foreign invader) cause secondary diseases and dangerous conditions, including diabetes, uncontrollable high blood pressure, kidney damage and failure, serious infections and cancers. The negative impact on recipients is not offset by effectiveness: the current transplant medicine regimen does not work well over time to protect donor organs from immune attack and destruction.

. . .

I am speaking for my transplant cardiologist, the finest physician I have ever known, who sat across from me last month and cried into his palms when he told me I had incurable cancer.

For the full essay, see:

Amy Silverstein. “My Donor Heart And I Will Die Soon.” The New York Times, SundayOpinion Section (Sunday, April 23, 2023): 8.

(Note: ellipsis added; in the original, the word “we” in the first sentence is in italics.)

(Note: the online version of the essay has the date April 18, 2023, and has the title “My Transplanted Heart and I Will Die Soon.”)

Mice on Taurine Lived 10% Longer and Looked Healthier

(p. A3) Scientists are exploring a new biological link to longer life.

Boosting levels of an amino acid called taurine made mice and worms live longer, according to research published Thursday [June 7, 2023] in the journal Science. Middle-aged monkeys given taurine supplements became healthier, researchers said. In humans, lower levels of taurine were associated with age-related problems.

“This is a very promising molecule,” said Vijay Yadav, an assistant professor of genetics and development at Columbia University, who co-wrote the paper.

People have been searching for life-extending substances for millennia. Other recent studies have explored antiaging properties of compounds including resveratrol, found in red wine, and the immunosuppressive drug rapamycin. Yadav said he first suspected taurine’s connection with aging over a decade ago when his lab compared the contents of blood drawn from people of different ages.

. . .

Researchers gave daily doses of taurine to hundreds of 14-month-old mice, considered middle-aged, and compared their average lifespans to mice that didn’t get extra taurine. The female mice given taurine lived 12% longer on average and male mice that got taurine lived 10% longer, researchers said.

Mice that received taurine also appeared to be healthier.

For the full story, see:

Dominique Mosbergen. “Amino Acid Found To Slow Down Aging.” The Wall Street Journal (Friday, June 9, 2023): A3.

(Note: ellipsis, and bracketed date, added. The online version is longer, but the passages quoted above appear in both versions.)

(Note: the online version of the story was updated June 9, 2023, and has the title “Is Taurine the Key to Longer Life? It Made Monkeys Healthier.”)

The Science paper on taurine mentioned above is:

Singh, Parminder, Kishore Gollapalli, Stefano Mangiola, Daniela Schranner, Mohd Aslam Yusuf, Manish Chamoli, Sting L. Shi, Bruno Lopes Bastos, Tripti Nair, Annett Riermeier, Elena M. Vayndorf, Judy Z. Wu, Aishwarya Nilakhe, Christina Q. Nguyen, Michael Muir, Michael G. Kiflezghi, Anna Foulger, Alex Junker, Jack Devine, Kunal Sharan, Shankar J. Chinta, Swati Rajput, Anand Rane, Philipp Baumert, Martin Schönfelder, Francescopaolo Iavarone, Giorgia di Lorenzo, Swati Kumari, Alka Gupta, Rajesh Sarkar, Costerwell Khyriem, Amanpreet S. Chawla, Ankur Sharma, Nazan Sarper, Naibedya Chattopadhyay, Bichitra K. Biswal, Carmine Settembre, Perumal Nagarajan, Kimara L. Targoff, Martin Picard, Sarika Gupta, Vidya Velagapudi, Anthony T. Papenfuss, Alaattin Kaya, Miguel Godinho Ferreira, Brian K. Kennedy, Julie K. Andersen, Gordon J. Lithgow, Abdullah Mahmood Ali, Arnab Mukhopadhyay, Aarno Palotie, Gabi Kastenmüller, Matt Kaeberlein, Henning Wackerhage, Bhupinder Pal, and Vijay K. Yadav. “Taurine Deficiency as a Driver of Aging.” Science 380, no. 6649 (June 9, 2023): eabn9257.

Longevity Proof of Concept–A Jellyfish That Can Return to a Younger Form

(p. A15) When Benjamin Franklin wrote that “nothing can be said to be certain, except death and taxes,” he must have thought he was stating an eternal truth. But if biotechnology researcher Nicklas Brendborg is to be believed, Franklin’s joke may need some updating. According to Mr. Brendborg, scientists have discovered a jellyfish the size of a fingernail that responds to stress by “ageing backwards,” reversing the normal direction of its development to become a bottom-dwelling polyp. This trick can be repeated over and over again with “no physiological recollection of having been older,” he explains, making this jellyfish “an example of the holy grail of ageing research—biological immortality.”

This tiny Methuselah is one of the striking examples in Mr. Brendborg’s breezy survey of the science of longevity, “Jellyfish Age Backwards,” which the author has translated from the Danish with Elizabeth DeNoma.

. . .

Short chapters built from short, declarative sentences combine with familiar material to give “Jellyfish Age Backwards” the feel of an introductory survey rather than a novel argument. Perhaps its piecewise construction is only a reflection of the disjointed state of the subject, where researchers are pulling on various threads but have not yet managed to knit them into a coherent whole. Mr. Brendborg finishes with a ringing declaration that the “noble” efforts of medical science will “eventually defeat” aging. But biology is complicated, as the author admits, and the strands of this multivariate and complex phenomenon may eventually prove to be tangled in some unresolvable knot.

For the full review, see:

Richard Lea. “BOOKSHELF; Dying Young At a Late Age.” The Wall Street Journal (Friday, Dec. 30, 2022): A15.

(Note: the online version of the review has the date December 29, 2022, and has the title “BOOKSHELF; ‘Jellyfish Age Backwards’ Review: Dying Young at a Late Age.”)

The book under review is:

Brendborg, Nicklas. Jellyfish Age Backwards: Nature’s Secrets to Longevity. Translated by Elizabeth DeNoma. New York: Little, Brown & Company, 2023.

Scientists Resurrect “Sweet and Possibly Medicinal” Judean Date Palm Pushed to Extinction by Roman Soldiers

(p. C11) The Judean date palm, prized for its sweet and possibly medicinal fruits, had been a feature of the landscape of biblical Israel. In the aftermath of the failed Jewish rebellion at the fortress of Masada in A.D. 73, Roman soldiers set about destroying the date trees, . . .

. . .

The few remaining Judean palms eventually died out. Yet the species wasn’t gone forever, as Martin Lemelman tells children in a captivating graphic novel,”The Miracle Seed.”

With economical text and expressive panel illustrations, Mr. Lemelman recounts the story of the tree’s astounding 21st-century resurrection. Among the detritus left at Masada, he explains, was an earthenware jar containing six Judean palm seeds.

. . .

“The Miracle Seed” not only reads like an adventure but also exudes an optimism of the kind that children ages 8-14 deserve.

For the full review, see:

Meghan Cox Gurdon. “Coaxing New Life From Ancient History.” The Wall Street Journal (Saturday, March 25, 2023): C11.

(Note: ellipses added.)

(Note: the online version of the review has the date March 24, 2023, and has the same title as the print version.)

The book under review is:

Lemelman, Martin. The Miracle Seed. Grand Rapids, MI: Eerdmans Books for Young Readers, 2023.

Yale Economist Says Stagnant Japan Would Benefit from Mass Suicide of Elder Citizens

A growing number of so-called “progressives” are advocating an end to economic growth. I do not believe that most of them understand how much more suffering and death the world will experience if their advocacy succeeds. (I remember decades ago seeing a beautiful but troubling Japanese movie with my friend Hajime Miyazaki, in which the loving, aging matron of a starving family was willingly carried up a mountain by one of her sons and left there so the other members of her family would have more to eat.)

(p. A1) In interviews and public appearances, Yusuke Narita, an assistant professor of economics at Yale, has taken on the question of how to deal with the burdens of Japan’s rapidly aging society.

“I feel like the only solution is pretty clear,” he said during one online news program in late 2021. “In the end, isn’t it mass suicide and mass ‘seppuku’ of the elderly?” Seppuku is an act of ritual disembowelment that was a code among dishonored samurai in the 19th century.

. . .

(p. A10) Given Japan’s low birthrate and the highest public debt in the developed world, policymakers increasingly worry about how to fund Japan’s expanding pension obligations.

. . .

In Japanese folklore, families carry older relatives to the top of mountains or remote corners of forests and leave them to die.

. . .

In broaching euthanasia, Dr. Narita has spoken publicly of his mother, who had an aneurysm when he was 19. In an interview with a website where families can search for nursing homes, Dr. Narita described how even with insurance and government financing, his mother’s care cost him 100,000 yen — or about $760 — a month.

For the full story, see:

Motoko Rich and Hikari Hida. “Scholar Suggests Mass Suicide for Japan’s Old. Does He Mean It?” The New York Times (Monday, Feb. 13, 2023): A1 & A10.

(Note: ellipses added.)

(Note: the online version of the story has the date Feb. 12, 2023, and has the title “A Yale Professor Suggested Mass Suicide for Old People in Japan. What Did He Mean?”)

As People Die of “Old Age” Will the FDA Ever Approve Longevity Drugs?

The FDA has required that new drugs be proven to be effective against a disease, and the FDA has refused to consider old age to be a disease. Perhaps as more government institutions give “old age” as the reason for a death, the FDA will reconsider.

(p. A6) LONDON — Queen Elizabeth II died of “old age,” according to her death certificate, which was released on Thursday by the registrar general of Scotland. The certificate, which lists her occupation as Her Majesty the Queen, also notes that the queen died at 3:10 p.m. on Sept. 8 [2022] at Balmoral Castle.

The first fact is indisputable, given that the queen was 96. But the report offers no further details about the cause of her death, which came two days after she was photographed standing and smiling as she greeted Britain’s new prime minister, Liz Truss.

For the full story, see:

Mark Landler. “Record Says Queen Died of ‘Old Age’.” The New York Times (Friday, September 30, 2022): A6.

(Note: bracketed year added.]

(Note: the online version of the story has the date Sept. 29, 2022, and has the title “Queen’s Death Certificate Reveals Cause and Time of Death.”)

Heat Deaths Rise Mostly Due to Rise in Fragile Aging Population

(p. A17) One recent and much-cited Lancet report appears deliberately deceptive.

The study offers a frightening statistic: Rapidly rising temperatures have increased annual global heat deaths among older people by 68% in less than two decades. That stark figure has been cited all over, from the BBC and Time to the Washington Post and the Times of India, the world’s largest-selling English-language daily.

. . .

Annual heat deaths have increased significantly among people 65 and older world-wide. The average deaths per year increased 68% from the early 2000s to the late 2010s. But that is almost entirely because there are so many more older people today than there were 20 years ago, in no small part thanks to medical innovations that keep us alive longer. Measured across the same time span the Lancet maps heat deaths, the number of people 65 and older has risen by 60%, or almost as much as heat deaths. When the increase in heat mortality is adjusted for this population growth, the actual rise that can be attributed to rising temperatures is only 5%.

It is hard not to see the Lancet study’s failure to adjust this figure as a deliberate act of deception.

For the full commentary, see:

Bjorn Lomborg. “The Lancet’s ‘Heat Death’ Deception.” The Wall Street Journal (Saturday, November 5, 2022): A17.

(Note: ellipsis added.)

(Note: the online version of the commentary has the date November 4, 2022, and has the title “Climate Change and the Lancet’s ‘Heat Death’ Deception.”)

The “Longevity Under Adversity” of the Bristlecone Pine “Is a Metaphorical Dose of Qualified Hope in an Unstable World”

(p. C9) . . ., trees seem to grow on a timescale humans can comprehend. A seed planted by a child will be largely mature when she is—and will likewise get thicker and wrinklier as it ages. The tree, however, might long outlive her; there’s a reason we use the shape of a tree to chart the chain of human generations.

This intertwining of biology and chronology is the subject of Jared Farmer’s rich but overstuffed “Elderflora: A Modern History of Ancient Trees.”

. . .

Mr. Farmer, raised in Utah, is partial to the Great Basin of the American West, cradle of the oldest living things securely dated: gnarled specimens of bristlecone pine. The coronation of bristlecones in the 1950s followed a few decades of scientific progress. Counting rings had long been the main method of tree dating, one that held an intuitive power even beyond the laboratory. Slices of big trunks marked with purportedly significant dates had become popular exhibits, a way to make time tangible. Scientists at the University of Arizona perfected the trick of combining multiple samples and lining up shared clumps of thick and thin rings—caused by year-to-year variation in climate—to extend the chronology beyond the span of a single specimen.

Using this technique, the pioneering dendrochronologist Edmund Schulman pegged one bristlecone at more than 4,500 years old, announcing his discovery in a National Geographic article whose publication he didn’t live to see. Mr. Farmer chronicles Schulman’s career in novelistic close-third-person narration—one more idiosyncrasy in this fascinating farrago of a book—lingering on Schulman’s coinage “longevity under adversity.” For Schulman, the phrase was a tribute to the bristlecone’s ability to endure extreme conditions through partial death; for Mr. Farmer, it is a metaphorical dose of qualified hope in an unstable world.

For the full review, see:

Timothy Farrington. “Time Made Tangible.” The Wall Street Journal (Saturday, Dec. 3, 2022): C9.

(Note: ellipses added.)

(Note: the online version of the review has the date December 2, 2022, and has the title “‘Elderflora’ Review: Ancient Trees Grow Among Us.”)

The book under review is:

Farmer, Jared. Elderflora: A Modern History of Ancient Trees. New York: Basic Books, 2022.