''WHY I WANT TO DIE AT 75''

Death – along with sex – is one of our two great taboos. So it came as some surprise when Ezekiel Emanuel took to the stage in New York. Here, at 57 and in full health, he is already planning the date of his death – at 75. “My brother called me on my birthday and said, ’Is it 17 or 18 more years that I have to put up with you?’” According to Ezekiel, “I think by 75 you’ve lived through the full arc of life... You’ve worked hard as an adolescent, you’ve made a career and had a family. That seems like a great life to me, so why run the risk of dementia, drooling, and being a burden to your family?”


The statement is all the more surprising, considering that Emanuel is an oncologist and the director of the Clinical Bioethics Department at the US National Institutes of Health. He surely knows more than most about the potential of modern medicine. Yet he says it is important that we all consider the nature of our deaths, as hard as that may be. Is there an ideal time to die, and should we choose to end our lives at that point?


Emanuel has been talking about the question for much of his adult life. “My kids have been hearing it since they were in diapers,” he told the conference delegates. He wrote an article for The Atlantic magazine stating: “Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value. But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.”

Jon Sopel and Ezekiel J Emanuel discuss life and death at the World-Changing Ideas Summit in New York

Jon Sopel and Ezekiel J Emanuel discuss life and death at the World-Changing Ideas Summit in New York

Provocative argument
It’s important to note that Emanuel is not suggesting that people should take deliberate action to accelerate death; rather, once he reaches 75 he will simply refuse medical care – such as chemotherapy, a pacemaker or statins– that could prolong his life. “It’s about not being driven by the medical establishment to take every medicine. Even antibiotics will be off the cards,'' he says. Even so, his point of view seems hard to reconcile with the fact that Emanuel has long opposed legalised euthanasia for the terminally ill. But it’s important to note this is a personal choice; he certainly isn’t suggesting that it should impact policies for health care. Changing the law to allow assisted suicide creates many more legal and moral issues that are far more difficult to resolve and could be abused, he says.


One issue that Emanuel readily acknowledges is that everyone will age differently. “Almost everyone’s initial response to my article was to list the 27 people they know who are over 75, and there are things you can do if you want to live a vigorous, engaged, intellectually vibrant life: excercise is important; continue to have a large social sphere, and keep working – because it forces you to have social interactions and do a routinised thing of having a plan, and getting things done. Yes, those things might boost you chances of being an outlier – but remember, we can’t all be outliers.”


Ultimately, he admits the specific limit, of 75 years, is somewhat arbitrary – but his point is that it makes you start to consider where your life is heading; the ultimate memento mori. “I’m challenging people to think about their personal philosophy,” he says; he’s certainly not suggesting that others follow him. “I think one of the problems, if you don’t set a date, is that you don’t confront the big question, and you don’t perceive you decline,” he says. “I want to shift to focus to saying ‘you’ve got 75 years, what are you going to make of it?’”

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BRITISH NATIONAL CONTRACTS EBOLA

A British national living in Sierra Leone has tested positive for Ebola, the first Briton to fall victim to the deadly disease that has spread across the West African region since March 2014.

Some aid organizations, including medical charity Medecins Sans Frontieres, have warned that the outbreak, which began in Guinea before spreading to Sierra Leone, Liberia and Nigeria, is now out of control.

Britain's Deputy Chief Medical Officer John Watson confirmed a British national was among those suffering from Ebola and said medical experts were assessing the situation in Sierra Leone to ensure appropriate care was provided. "The overall risk to the public in the UK continues to be very low," Watson said in a statement.


No further details about the British national were immediately available, and it was not known whether there were plans to evacuate the patient.


Ebola, which is passed on by direct contact with the bodily fluids of infected persons, strikes hardest at healthcare providers and caregivers who work closely with those infected. And dozens of local doctors and nurses have died from the virus in recent months.


Fear, stigma and denial have led many families to hide their infected loved ones from health officials. In other instances, patients have been forcibly removed from treatment facilities and isolation centers, creating the risk of the disease's further spread. Lawmakers in Sierra Leone on Friday voted overwhelmingly in favor of making the harboring of those infected with Ebola a crime carrying a punishment of two years in prison.                                                        

The WHO does not recommend travel or trade restrictions for countries affected by Ebola, saying such measures could heighten food and supply shortages. The Philippines on Saturday ordered 115 soldiers to return home from peacekeeping operations in Liberia due to the outbreak there. Brussels Airlines, Belgium's largest carrier, said on Saturday it was cancelling flights to the capitals of Guinea, Liberia and Sierra Leone for two days due to new restrictions put in place by Senegal's aviation authority. The company's flight to Freetown on Friday was denied permission to land for a crew change at the airport in Senegal's capital Dakar, and the plane was forced to continue on to Casablanca for an unscheduled landing.




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THE PHYSICAL TRIGGERS OF SUICIDE

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Robin Williams' publicist has confirmed that Williams had been battling depression in the months leading up to his suicide. More people in the United States now die of suicide than in automobile accidents. Then there are people who still consider suicide a selfish act that can be cured with willpower.


Anti-depressant drugs and cognitive behavioural therapy seem to reduce suicidal thoughts for many people with depression – but they are not a perfect cure for every patient. Why some respond, while others don’t, has been the matter of much soul searching, but recent research is helping to shed a little light on this dark state of mind. For instance, there is a growing recognition that the disease we call “depression” could be an umbrella-term covering many distinct problems, each with a different biological origin. In particular, a suicide attempt may be foreshadowed by a string of neurological changes that are not found in people with other kinds of depression. Of the most noticeable differences, patients who have tried to kill themselves seem to have less of the white-matter connections that transmit information in the dorsomedial prefrontal cortex – the part of the brain right behind your forehead’s hairline. That’s significant, since this region helps us process our self-awareness.


People who try to kill themselves seem to get stuck in ruminative, negative styles of thinking full of self-criticism – so I wonder if the neurological changes could lie behind those destructive trains of thought, blinding people to the hope and promise of the future, and even of their sense of their own self-worth.


People feeling suicidal thoughts also seem to have reduced connectivity in the frontal areas of the brain associated with emotional control and inhibition. Suicide is considered to be an impulsive action, so it could be that the abnormal wiring in these regions makes it harder for someone to cope with the urge for self-destruction. On top of these specific changes, the brain cells themselves seem to be wasting away across diverse regions of the brain, potentially impairing problem solving and decision making – cognitive problems that are commonly seen in people who have attempted suicide.


At the moment, it’s not clear what triggers these anatomical changes and whether they are the primary cause of the suicidal urges – it could be that they are just a side-effect of the depressed, desperate feelings that the patient is already experiencing. Most likely, the psychological symptoms and the altered brain wiring are both the result of a complex interplay between your genes and your circumstances.


Many suicidal patients are unlikely to tell anyone, even their doctors, about their darkest feelings – but a brain scan might reveal those characteristic anatomical changes, giving doctors an insight that they couldn’t have gained from an interview. Since neural degeneration – such as the death of neurons – has certain chemical signatures, some have suggested that blood tests could one day reveal the early signs that could precede a suicide attempt.
Once the patients’ particular needs have been identified, the work could then tailor treatments that best suit the particular type of depression they have. Doses of lithium, for instance, seem to replenish the grey matter in damaged areas of the suicidal brain; and studies have found that the drugs do indeed reduce the risk of a second suicide attempt, when applied to people with bipolar disorder who have already attempted to take their life once. 

Kees van Heeringen at the Unit for Suicide Research in Ghent University in Belgium has proposed that upcoming, non-invasive forms of brain stimulation like Transcranial Magnetic Stimulation (TMS) could also be of interest. Using a magnet on the scalp, TMS can boost or reduce the electrical activity in specific parts of the brain. It has already helped bring relief to people with other kinds of depression that had resisted treatment, and it could potentially target the regions most affected in people with suicidal feelings, curtailing their destructive urges.


It is unlikely that any single treatment will ever be a panacea for people suffering from severe and suicidal depression. If you feel suicidal yourself, or know someone who might be, the advice is to seek medical help as soon as possible.


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CONFUSION OVER BEST WAY TO BRUSH TEETH

Advice on the best way to brush teeth for adults and children is confusing and inconsistent. There is also a lack of agreement on how often to brush and for how long because of an absence of good research. Experts say there is no evidence that one method is better than another.

The most commonly-recommended toothbrushing method involves a horizontal brush movement with some circular motions. But six different tooth-brushing techniques are recommended by dentists and dental associations. Some involve angling the brush at 45 degrees, others involve vertical brush movements while using the brush to 'scrub' the teeth was also recommended.

Most of the advice suggested brushing teeth twice a day, but one source said it should be three times daily. When it came to how long to brush teeth for, 26 sources advised brushing for two minutes, 12 for two to three minutes and two sources recommended three minutes of brushing. There appears to be no consensus among professional bodies on the best method of toothbrushing for the general population or for people of different ages or with particular dental conditions.

The wide diversity in recommendations, for something that is done twice a day, should be of serious concern to the dental profession. There is an urgent need for more research into the comparative effectiveness of brushing methods.

No one brushing technique has been shown to be better than any other.

Prof Damien Walmsley, scientific adviser at the British Dental Association, warns that there is little point brushing teeth straight after eating sugary foods to prevent tooth decay. Bacteria from food starts producing acid after a few minutes, which softens the enamel on the teeth, so brushing during this time could damage the enamel. "Leave it for an hour or so," he advises.

My advice: brush teeth with fluoride toothpaste twice a day for at least two minutes to help keep teeth and mouth healthy.


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WHY DO WE YAWN?

Mid-conversation, I have a compelling urge, rising from deep inside my body. The more I try to quash it, the more it seems to spread, until it consumes my whole being. Eventually, it is all I can think about – but how can I stop myself from yawning?
You talk and then the audience starts yawning. And then you can ask people to experiment on their yawns – like closing the lips, or inhaling through clenched teeth, or trying to yawn with the nose pinched closed. It is through experiments like these that we can try to explore a millennia-old mystery: why do we yawn? We all know that tiredness, boredom, or the sight of someone else can all bring along the almost irrepressible urge – but what purpose does it serve the body? Yawning may have the dubious distinction of being the least understood, common human behaviour. We may be closer to an answer, but it’s one that has split the field.

Arguably the first studier of yawns was the Greek physician Hippocrates nearly 2,500 years ago. He believed that yawning helped to release noxious air, particularly during a fever. “Like the large quantities of steam that escape from cauldrons when water boils, the accumulated air in the body is violently expelled through the mouth when the body temperature rises,” he wrote. Different incarnations of the idea lingered until the 19th Century, when scientists instead proposed that yawning aids respiration – triggering a rush of oxygen into the blood supply, while flushing out the carbon dioxide. If that were true, you would expect people to yawn more or less frequently depending on the oxygen and carbon dioxide concentrations in the air. Yet when volunteers were asked to breathe various mixtures of gases, no such change was found.


Many theories have instead focussed on the strange, contagious nature of yawning. Around 50% of people who observe a yawn will yawn in response. It is so contagious that anything associated with it will trigger one… seeing or hearing another person, or even reading about yawning. For this reason, some researchers have wondered if yawning might be a primitive form of communication – if so, what information is it transmitting? We often feel tired when we yawn, so one idea is that it helps set everyone’s biological clocks to the same rhythm. In my view the most likely signalling role of yawning is to help to synchronize the behaviour of a social group – to make them go to sleep more or less at the same time. With the same routine, a group can then work together more efficiently throughout the day.




Danario Alexander of the San Diego Chargers yawns before the start of an American football match

Yet we also yawn during times of stress: Olympic athletes often do it before a race, while musicians sometimes succumb before a concert. So some researchers believe that the strenuous movements might have a more general role in rebooting the brain – when you are sleepy they make you more alert, or when you are distracted they make you more focussed. Spreading through a group, contagious yawns could then help everyone reach the same level of attention, making them more vigilant to a threat, for instance. With so many competing and contradictory ideas, a grand unifying theory of yawning may seem like a distant speck on the horizon. But over the last few years, one underlying mechanism has emerged that could, potentially, appease all these apparent paradoxes in one fell swoop. Andrew Gallup was first inspired with the idea during his undergraduate degree, when he realised that yawning might help to chill the brain and stop it overheating. The violent movement of the jaws moves blood flow around the skull, he argued, helping to carry away excess heat, while the deep inhalation brings cool air into the sinus cavities and around the carotid artery leading back into the brain. What’s more, the strenuous movements could also flex the membranes of sinuses – fanning a soft breeze through the cavities that should cause our mucus to evaporate, which should chill the head like air conditioning.

The most obvious test was to see if people are more or less likely to yawn in different temperatures. In normal conditions, Gallup found that around 48% felt the urge to yawn, but when he asked them to hold a cold compress to their foreheads, just 9% succumbed. Breathing through the nose, which could also cool the brain, was even more effective, completely dampening his subjects’ urge to yawn – potentially suggesting a handy trick for anyone facing embarrassment during a tedious conversation.


Perhaps the best evidence comes from two troubled women who approached Gallup soon after he first published his results. Both were looking for relief from pathological yawning attacks, sometimes lasting an hour at a time. “They’d have to walk away and go to a secluded area – it affected their personal and professional lives,” says Gallup. Intriguingly, one of the women found the only way to stop the yawning attack was to throw herself into cold water. Inspired, Gallup asked them to place a thermometer in their mouths before and after the attacks. Sure enough, he saw a slight rise in temperature just before the yawning bouts, which continued until it dropped back to 37C.
Importantly, this brain chill might underlie the many, seemingly contradictory, events that lead to yawning. Our body temperature naturally rises before and after sleep, for instance. Cooling the brain slightly might also make us more alert – waking us up when we are bored and distracted. And by spreading from person to person, contagious yawns could therefore help a whole group to focus.




Does this picutre make you yawn?

Gallup’s unified theory has been somewhat contentious among yawning researchers. “Gallup’s group has failed to present any convincing experimental evidence to support his theory,” says Hess. In particular, his critics point out he hasn’t made direct measurements of temperature changes in the human brain, though Gallup says he has found the expected fluctuations in yawning rats. Even if Gallup has managed to find that unified theory, many mysteries remain. Why do foetuses yawn in the womb, for instance? It could just be that they are practicing for life outside, or perhaps the yawn plays a more active role in guiding the body’s growth – by helping to develop articulation in the jaws joints, for instance, or by encouraging the growth of the lungs.


Yawning – and perhaps other bodily functions, like sneezing – shares some strange parallels with sex. The facial expressions involved are surprisingly similar – just take a look at this picture and you can see where he’s coming from.




Like sex, yawns and sneezes involve a build-up that ends in a pleasant climax

Once initiated, they go to completion – you don’t want a yawnus interruptus. As evidence, that certain anti-depressants can lead ome patients to orgasm during a yawn – a rare side effect that could quickly lose its appeal.


I’m willing to bet you’ve been stifling a few yawns yourself by this point. So go ahead, let it out – and do so in the knowledge that you are enjoying one of life’s most enduring mysteries.


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BOY HAS EARS CREATED FROM RIBS

A boy who was born without ears has had a pair created from his ribs.

Nine-year-old Kieran Sorkin had the surgery at London's Great Ormond Street Hospital. About 100 children a year in the UK are born without one or both ears, a condition known as microtia.

Kieran was born deaf with small lobes where his ears should be. He can already hear, thanks to previous surgery to implant a hearing aid. "I want people to stop asking me questions", said Kieran from Hertfordshire. "I'd like just to look like my friends. "I'd also like to be able to wear sunglasses and earphones."

Kieran's mum Louise Sorkin said: "He's a very sociable boy and has longed for this operation for years. "I don't want children bullying him because he's different. I just want him to be accepted like everyone else."

In theatre the surgical team remove cartilage from six of his ribs. It is cut, shaped and sewn.

These frameworks are inserted in pockets in the skin and then using suction, they take on the shape of an ear on both sides. The surgery is cosmetic, not to improve hearing. Three days after surgery, Kieran is given a mirror to look at his new ears. His first reaction was "Wow!". Kieran started to giggle, but the operation on his ribs means it hurts when he laughs. Kieran will need a second operation in six months to make his ears stand out from the scalp more, but he's already delighted with the result.

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BEING OVERWEIGHT LINKED TO CANCER

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Being overweight and obese puts people at greater risk of developing 10 of the most common cancers.

Scientists warn if obesity levels continue to rise there may be an additional 3,700 cancers diagnosed annually.

Doctors often warn being overweight can increase the risk of developing cancer, but a new study highlights those forms of the disease where the risk is greatest. They found each 13-16kg (2-2.5 stone) of extra weight an average adult gained was linked firmly and linearly to a greater risk of six cancers.

How big this risk was varied depending on tumour type.

• Cancer of the uterus had the highest increased risk
• gallbladder
• kidney
• cervix
• thyroid
• leukaemia had the lowest rise in risk.

People who had a high body mass index (calculated using weight and height) were also more likely to develop cancer of the liver, colon, ovaries, and post-menopausal breast cancer. But the effects for these cancers were less clear-cut and were influenced by individual factors such as the menopause. Dr Krishnan Bhaskaran, who led the research, said: "There was a lot of variation in the effect of BMI on different cancers. For example, risk of cancer of the uterus increased substantially at higher body mass index, for other cancer we saw no effect at all. This variation tells us BMI must affect cancer risk through a number of different processes, depending on cancer type"

Tom Stansfeld, at Cancer Research UK, said: "It is clear carrying excess weight increases your risk of developing cancer. Keeping a healthy weight reduces cancer risk and the best way to do this is through eating a healthy, balanced diet and exercising regularly."


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EBOLA CRISIS TO LAST AT LEAST 6 MONTHS

The outbreak of Ebola in West Africa will take at least six months to bring under control, medical charity Medecins Sans Frontieres (MSF) says.

Speaking in Geneva, MSF President Joanne Liu said the situation was "deteriorating faster, and moving faster, than we can respond to".

The epidemic began in Guinea in February and has since spread to Liberia, Sierra Leone and Nigeria.

The death toll has risen to 1,145 after WHO said 76 new deaths had been reported in the two days to 13 August. There have been 2,127 cases reported.

Ms Liu said that although Guinea was the initial epicentre, the pace there had slowed, and other countries - particularly Liberia - were now the focus. "If we don't stabilise Liberia, we will never stabilise the region. In terms of timeline, we're not talking in terms of weeks, we're talking in terms of months. We need a commitment for months, at least I would say six months, and I'm being, I would say, very optimistic. All governments must act. It must be done now if we want to contain this epidemic," she said.




Ebola is transmitted by direct contact with the body fluids of a person who is infected. Initial flu-like symptoms can lead to external haemorrhaging from areas such as eyes and gums, and internal bleeding which can lead to organ failure. The WHO - which declared a global health emergency - recently said the risk of transmission of Ebola during air travel remained low, as the disease is not airborne. As a consequence, Kenya Airways has rejected pressure to suspend its flights to the Ebola-hit states of West Africa.


The WHO said in a statement that its staff had seen evidence that the number of reported cases and deaths did not reflect the scale of the crisis. Experts going house-to-house in Kenema, Sierra Leone, in search of infected people were discovering more cases. An 80-bed treatment centre that recently opened in Liberia's capital Monrovia filled up immediately and the next day, dozens more people turned up to be treated. Tarnue Karbbar, of the aid group Plan International in northern Liberia, said medical teams were not able to document all the cases erupting. He said many of the sick were being hidden at home by relatives, and many victims were buried before teams could get to the area.




The outbreak is also affecting the Youth Olympic Games about to start in China. The International Olympic Committee (IOC) has ruled that athletes from Ebola-hit countries will not be allowed to compete in combat sports or in the pool, and Sierra Leone and Nigeria have withdrawn from the Games.

Symptoms include high fever, bleeding and central nervous system damage

Fatality rate can reach 90% - but the current outbreak is about 55%

Incubation period is two to 21 days

There is no vaccine or cure

Supportive care such as rehydrating patients who have diarrhoea and vomiting can help recovery

Fruit bats are considered to be virus' natural host

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DEPRESSION MORE COMMON IN EARLY PARKINSON'S

Depression and anxiety are twice as common in people newly-diagnosed with Parkinson's disease compared with the general population. Research suggests that the disease's impact on the brain can be a trigger for depression.

Dr Daniel Weintraub, associate professor of psychiatry and neurology at the Perelman School of Medicine at the University of Pennsylvania, said "There are psychological reasons why people who have been diagnosed with a neuro-degenerative disease like Parkinson's can become depressed, but their brain pathways are also affected by the disease and these are closely associated with mood."

Depression, however, can be a sign of Parkinson's. It can also be a side effect of Parkinson's drugs. It is well-recognised that people do get depression and anxiety up to 10 years before they develop Parkinson's disease. People recognise the tremor and movement problems of Parkinson's, but the disease actually starts in the brain, affecting certain chemicals. This can cause sleep problems initially and can also lead to minor forms of depression.

After Robin Williams died in an apparent suicide last week, it emerged the actor - who had depression - was in the early stages of Parkinson's disease.


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MEDS THAT PREVENT HIV INFECTION & RISKY BEHAVIOUR

HIV-negative heterosexuals who take drugs that protect them from contracting the AIDS virus from their HIV-positive partners don't engage in more risky sexual behaviors, according to a new study.

Researchers from the University of Washington in Seattle found that knowing they are protected against HIV transmission doesn't change how these people behave sexually or lead them to have sex without a condom more often.

 

"Evidence for the effectiveness of new HIV-prevention strategies, including pre-exposure prophylaxis, has spurred optimism that the global HIV epidemic might be reversed," Dr. Jared Baeten said in a journal news release. "However, an important question is whether HIV-negative partners who know they're protected by prophylaxis will compensate for this by increasing their sexual risk-taking, such as through increasing their levels of unprotected sex."

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"The results provide encouraging evidence that behavioral changes as a result of pre-exposure prophylaxis might not undermine its strong HIV prevention and public-health benefits.

There was, however, a slight increase in the frequency of unprotected sex outside the relationship.

 

 

Culled from HealthDay News

 

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