The Ancients' Taste for Bone Marrow

"It was believed that early hominins were consuming everything they could put their hands on immediately, without storing or preserving or keeping things for later."
"This [study] is a game changer for our modern conceptions about our ancestors because it is believed that early hominids were not capable of or not accustomed to delayed consumption."
"This gives us a view of them as very similar to us [with the cognitive capacity to plan ahead] and not as some primitive human creatures."
"Until now, evidence has pointed to immediate consumption of marrow following the procurement and removal of soft tissues. In our paper, we present evidence of storage and delayed consumption of bone marrow at Qesem Cave."
"We show for the first time in our study that 420,000 to 200,000 years ago, prehistoric humans at Qesem Cave were sophisticated enough, intelligent enough and talented enough to know that it was possible to preserve particular bones of animals under specific conditions, and, when necessary, remove the skin, crack the bone and eat the bone marrow."
Ran Barkai, archaeologist, Tel Aviv University, Israel

Qesem cave in Israel

JACK GUEZ/AFP/Getty Images

"Prehistoric humans brought to the cave selected body parts of the hunted animal carcasses."
"The most common prey was fallow deer, and limbs and skulls were brought to the cave while the rest of the carcass was stripped of meat and fat at the hunting scene and left there. We found that the deer leg bones, specifically the metapodials, exhibited unique chopping marks on the shafts, which are not characteristic of the marks left from stripping fresh skin to fracture the bone and extract the marrow."
Prof. Jordi Rosell of Universitat Rovira i Virgili (URV) and Institut Català de Paleoecologia Humana i Evolució Social (IPHES)

Qesem Cave, its discovery locating it in central Israel not far from Tel Aviv, is valued as a time capsule of limestone revealing details of the lives and the diets of Paleolithic people dating from 420,000 to 200,000 years ago. A mind-boggling concept of ancient early human life to begin with, and one most people automatically ascribe to the most primitive of evolving humanity eking out a basic life of existence. Clues from the most recent forays into the cave by a team of archaeologists led by Ran Barkai, showed convincingly that ancient humans used stone-fashioned blades to butcher animals they hunted and then barbecued the resulting meat on their campfires.

"It was a surprise. The Qesem hominids have demonstrated very modern behaviour in their livelihood strategies", pointed out Ruth Blasco, zooarchaeologist at the National Research Center on Human Evolution in Spain, lead author on the study. The careful interpretation of the vast multitude of bones discovered in the cave and the marks that led to the hypothesis that further study revealed and confirmed, convinced the scientists that these ancient beings were adept at thinking outside their primitive box which would have had them immediately consuming all that fell into their hands after a hunt.

The cave's earliest inhabitants, according to Dr. Barkai and his colleagues, may also have decided to store marrow-filled animal bones for later consumption. The scientific guesswork based on their findings, appeared to suggest storage of these bones for a period of up to nine weeks, before total rancidity might set in. As such, this represents the earliest example of primitive humans taking well thought-out steps to preserve food for later consumption. A startling indication of an intelligence of these ancients leading them to plan for the future.

"[If the removal of dry skin did leave a unique butchery mark] it's now up to us zooarchaeologists to look for these traces in older fossil assemblages to see if we can document a greater antiquity of this food storage behaviour", commented Briana Pobiner, a paleoanthropologist at the Smithsonian National Museum of Natural History in Washington, who praised the study as a heads-up to other archaeologists who might never have noticed similar markings on bone fragments they may have found elsewhere in much the same manner as the Qesem Cave excavation, and in the light of this new revelation, take closer scrutiny to determine whether the same attention to future need was practised elsewhere.

The Qesem Cave team collected freshly killed deer leg bones for an experiment. The bones were stored for several weeks in conditions identical to what pertained within the cave, and after each week that passed, a researcher would remove dried skin from the bones, hammer a bone open to analyze the marrow and determine how nutritious it would be at each of those stages. The chop marks which were created by this experiment and visible on the bones, were found to be similar to those seen in the Qesem Cave. In the wake of nine weeks' storage the bone marrow fat was seen to have degraded only slightly, remaining nutritious.

Archaeological testing the longevity of marrow in deer leg bones. Credit: Ruth Blasco

Of course scientific researchers are extremely curious; a trait that is common to the profession that seeks answers to riddles about humankind's beginnings. If anyone would be interesed enough to wonder how the stored marrow might taste, there is someone on the team who could respond with authority on the matter. "It is like a bland sausage, without salt, and a little stale I can say that its taste was not bad, perhaps a little more rancid in the last weeks, but not bad", assured Jordi Rosell, an archaeologist at Rovirai Virgili University in Spain.

Privacy, Please!

"I've had a shy bladder all my life. You  tend to get cramped, minimal lavatories, and especially from the point of view of women, that's why you get inadequate numbers of cubicles [disinterest in designing adequate dedicated bathroom space in public buildings]."
"Personal space boundaries lie at around three feet around you, and  you discover when standing side-by-side at a urinal that the distance is much less than that."
"Most councils realize they need to put lavatories in place. They want tourism, they have families, pregnant mums and kids. They want to bring all those people into the town to spend money and keep the whole commercial centre going. It's their money that keeps the shops and cafes open."
"What is very common among guys who have got parusesis who are struggling to use urinals, is they feel they're being noticed or even judged."
"They think normal behaviour is that you're able to start to pee instantly. They're unaware that's not the case."
"I tell people I'm on the shy end of the normal range."
Andrew Smith, 73, chairman, U.K. Paruresis Trust 

"I avoid public bathrooms at all costs."
"When on a night out, I'll limit the amount I drink so [as] to avoid having to pee. Bars and nightclubs are the worst because they're so crowded."
Unnamed man, 30

"The figures are a bit rubbery, but the prevalence estimates you get for levels of inhibition and distress that gets to the point of being reasonably serious is around five to ten percent [of the population affected]."
"The main concern is just being observed and judged negatively while engaged in this behaviour [going to the bathroom]."
Nick Haslam, professor of psychology, University of Melbourne

"Cost is the issue. There is no government legislation to provide public lavatories, and there's no government funding."
"Most new lavatories, both private and public, are individual, lockable cubicles now."
"[In response to smelly urinals] The pipes build up uric salts and the ammonia leaches back into the room."
Raymond Martin, British Toilet Association lobby

Thought it was just you, did you? Convinced it was only you who felt such a straitened distaste for doing private business in what is essentially a public place? You're not alone. Paruresis, the medical term for shy bladder syndrome, is a fear of publicly peeing that afflicts quite a few people, both men and women. Women, of course, don't have to make do with urinals placed directly beside each other where men casually unzip and let go in close proximity. Except that some men don't unzip and go. They agonizingly hold it all in.

They may make the attempt, but are unable to perform. And sometimes the situation is sufficiently traumatizing that they will make a decision to stay home as much as they can so they can avoid a situation where they cannot relieve themselves. Some men on the mild end of the spectrum will make do when instead of urinals there are discrete cubicles, and they manage to convince themselves there is adequate privacy to unlock their frozen bladder.

Dr. Haslam, author of the book Psychology in the Bathroom, discusses what was once called a social phobia; fear of doing things while feeling you're being actively observed. A signal is sent to the brain when someone feels the urge to empty their bladder, to open sphincters allowing urine to flow. For some men and women, social fear is linked to another signal in the autonomous nervous system preventing the sphincter from opening.

Signs of Paruresis

Paruresis can range from mild to severe. Symptoms of paruresis include the following:

• Needing complete privacy when using a restroom
• Fear that other people will hear you when using the restroom
• Complete inability to use toilets other than at home
• Feeling anxious about needing to use a toilet
• Not drinking so that you won't have to use the restroom
• Avoiding events because of the need to use the public restroom
• Negative thoughts about yourself when using the restroom

Some men try to cope by choosing an unoccupied urinal distant from any that are occupied. This won't work for the most severe paruresis sufferers. Raymond Martin, representing the British Toilet Association, lobbies councils and private companies in the U.K. for better design of public lavatories, sitting on the board of the British Standards Institute as well, to set the recommended minimum standards for bathrooms.

Minimum guidelines for bathrooms to include privacy boards between each urinal to allow men a sense of modesty protection in the hopes of tackling paruresis so they can pee in peace, are his specialty. His success rate is modest, he admits, as a result of costs involved. But he sees hope in the fact that the rise of unisex lavatories is eliminating urinals in favour of compartmentalized bathrooms where doors can be closed and locked and the temporary residents can find privacy.

In the meanwhile, paruresis sufferers from age 14 to 85 can attend workshops for men and women run by the U.K. Paruresis Trust where courses designed by psychologists revolve around a "talking cure". Mostly, the workshops make an effort to dispel the myths associated with fear of public exposure such as those whose bladders freeze are unlike 'normal' people where free flow of urine is instant and over with. The social bonding that takes place at the workshops allows people to realize that the problem is widespread, they are not 'abnormal'.

Joey Boylan / Getty Images

Male Manopause: Myth or Reality?

"Referring to it as the male menopause or 'manopause' is a bad idea, as women rightly feel that's an appropriation of a specifically female complaint."
"But, while men often think of hormonal changes as a 'women's thing', it can happen to them, too."
"If a man in his 50s complains about a low libido, there's a tendency for his doctor to say: 'What do you expect, you're too old to be a sex god anymore'. But if that's harming the patient's sex life, why not at least investigate?"
"After all, we don't tell people they don't need glasses or hip replacements as they get older."
Andrew Carruthers, managing director, Centre for Men's Health clinic, Great Britain

"Doctors should be more aware of the possibility of testosterone deficiency in a small minority of middle-aged and older men and be more prepared to measure testosterone levels."
"[TRT is not] a remedy for symptoms associated with aging."
Professor Frederick Wu, endocrinologist Manchester University

"Erectile dysfunction doesn't have a good correlation with low testosterone -- it's usually down to problems with arteries, which affect the flow of blood around the body."
"If you want to improve men's libido, you're much better looking at exercise, diet and lifestyle first. That may sound boring, but it's important."
"[With 'Big Pharma' now involved, the use of TRT may increase, even if there are those who believe it's an instance of] manspreading [in medicine], 'manopause' [may be here for good]."
Terry Maguire, community pharmacist, medical blogger

Is ‘male menopause’ a real thing? Well, sort of, but not really.  MDLinx

Men and women are certainly biologically different, playing different but complementary roles in the functioning of humanity but both understandably experience a decline through aging in vital hormones that underscore our biology. Men's symptoms of waning sex drive, weight gain, irritability are recognized and clinics are now and have been for awhile, particularly in the United States, offering testosterone replacement therapy (TRT).

The TRT industry in fact is booming in the United States where 13 million men are now actively undergoing the therapy as a treatment. Testosterine replacement therapy was once associated with bodybuilders and the fighting sports, but it is no longer monopolized by those groups, it has become a mainstream industry with millions of men taking it up as a solution to their low libido state and moodiness. Aggressive marketing campaigns aim directly at the average American male.

All this while the medical establishment has its doubts that "male menopause" is an actual condition, let alone whether treatment is necessary. The term itself is considered "unhelpful" on the website of Britain's National Health Service where it is pointed out that, men, unlike women, do not routinely experience a dramatic drop in hormones in middle age, much less specific alterations such as menstruation cessation. Weight gain and loss of sex drive are likelier, it suggests, to be caused by poor diet and lack of exercise.

Signs of low testosterone

MIND
• Depression
• Reduced self-confidence
• Difficulty concentrating
• Disturbed sleep
BODY
• Declining muscle and bone mass
• Increased body fat
• Fatigue
• Swollen or tender breasts
• Flushing or hot flashes
SEXUAL FUNCTION
• Lower sex drive
• Fewer spontaneous erections
• Difficulty sustaining erections

Male hormones are known to decline gradually from the age of 30 or 40 at the rate of two percent annually. On the other hand, a medically recognized condition, the andropause or hypogonadism (testosterone drops much more than normal) is well known. The British Society for Sexual Medicine last year issued guidelines suggesting levels of less than eight nanomoles per litre of blood should be viewed as a requirement for TRT, while over 12 should not.

A widely reported study produced by Mr. Carruthers' clinic (where TRT therapy is offered) in 2015 concluded one in five men may suffer from testosterone deficiency, even while other estimates place the number at one in ten, with only one in 50 likely to benefit from treatment. At the same time there is the obvious: that private clinics have a defined financial interest in offering treatments; incentivizing potential clients is good for that whopping big bottom line.

Understand the potential risks and consider alternatives before boosting your hormones indefinitely. Harvard Health Publishing, Harvard Medical School

A Word to the Wise: Be Humble, Forgiving and Kind

Abstract: We review humility, a trait characterized by (a) an ability to accurately acknowledge one’s limitations and abilities and (b) an interpersonal stance that is other-oriented rather than self-focused. We explore two key contexts of humility, intellectual and cultural; explain why humility is important; and identify open questions for future research.
Daryl Van Tongeren and research team, Hope College

Humility: Characterized by an ability to accurately acknowledge one's limitations and abilities and an interpersonal stance that is other-oriented rather than self-focused.

Humility, a vital characteristic, is hard to fake as a personality trait. Francesco Ciccolella, The New York Times

"Research on humility has been growing, and fast."
"It was time to bring people up-to-date and lay out in the open questions to guide further research."
"One of the thorny issues is that the people who are the most open and willing to cultivate humility might be the ones who need it the least."
"And vice versa: those most in need could be the most resistant."
Daryl Van Tongeren, psychologist, Hope College, Michigan

"These kinds of findings may account for the fact that people high in intellectual humility are not easily manipulated with regard to their views."
"[The findings may also] help us understand how humility can be associated with holding convictions."
Elizabeth Krumrei Mancuso, Pepperdine University, Malibu, California

People scoring high on the humility index scored concomitantly lower on measures of political and ideological polarization, irrespective of whether they fall into the conservative or liberal camp. People who score high for humility, according to research, tend to be less aggressive, less judgemental toward those belonging to religious groups other than their own, as opposed to less humble people.

In a series of experiments, Dr. Krumrei Mancuso scored volunteers on a measure of intellectual humility, construed as an awareness of how incomplete and fallible were their personal views on political and social issues. She discovered that this particular type of humility had no relation to IQ measures, nor with political affiliation; rather it was linked to curiosity, reflection and open-mindedness.

The latest issue of Current Directions in Psychological Science published a paper where a research team reviewed studies of the personal trait of humility. It is only relatively lately that social and personality psychology has recognized humility as a trait ripe for study. Its study derives from an effort dating from the 1990s to construct a "positive" psychology, allied with reaching a more complete vision of sustaining qualities like pride, forgiveness, grit and contentment.

Another study still in development by Dr. Krumrei Mancuso linked to questionnaires given to 587 adults for the purpose of measuring levels of intellectual humility where participants rated whether or not they agreed with a number of statements. Such as: "I feel small when others disagree with me on topics that are close to my heart", and, "For the most part, others have more to learn from me than I have to learn from them."

As in: from hubris to humility.

In the review paper of which Dr. Van Tongeren was the lead author, he and his colleagues proposed a number of explanations why humility, intellectual or otherwise, becomes a valuable portion of an individual's personality. Chief among them, that a humble disposition could be critical in sustaining a committed relationship. It may as well, nourish the capacity of a psychological resource to set aside grudges, suffer fools patiently and be kinder to oneself.

With the growing interest in humility as a positive and admirable character trait, Dr. Van Tongeren posits a number of open questions such as whether humility is able somehow to be taught, even integrated into psychotherapy. It is understood that between ten percent and 15 percent of adults achieve high scores on humility measures. Somewhat reassuring for the ability of people to be moderate in their responses toward others.

To expand that trait to others within society through a modulation of character traits, exposing people to the positive elements to be gained by acquiring a more tolerant attitude toward others along with patient perseverance and acceptance would be of huge societal benefit.

Emerging Weight-Loss Strategies, Pharmaceuticals

"This time around we know much more about the biology and patho-physiology of obesity."
"Everyone [clinicians, before 2010, convinced that people could be spurred to burn more calories] felt that if we could just get a medication that increased metabolic rate, that would work."
"Everything starts moving faster and causes lots of problems [when metabolism is chemically driven]."
"[For full safety effects with the use of some drugs] you need years on a drug. But at the very least, we're showing people are staying on the medication for a longer period of time, because it's tolerable, and it's working [new generation of drugs]."
Dr.Sean Wharton, internal medicine specialist, McMaster University

"Every medication industry goes through its 20 or 30 years of nonsense, where nothing works and things aren't safe."
"We're coming out the other side now. We have effective and safe medications that are already making significant changes in someone's ability to lose weight and keep it off."
Dr.David Macklin, medical director, weight management program, Mount Sinai Hospital, high risk/special pregnancy BMI unit, Toronto

"However you look at it, obesity is deleterious for health - functionality, mental health and metabolic health. [The history of medical treatments, early anti-obesity pills] has been a bit of a train wreck."
"[But] drugs will be important for the management of obesity and, I think, especially for weight loss maintenance."
"With the new acceptance of injectable [peptides] we will have more success and probably less side effects."
Dr.Eric Ravussin, editor-in-chief, Journal Obesity, associate executive director, clinical science, Louisiana State University Pennington Biomedical Research Center, Baton Rouge

A 2018 study in the Lancet Diabetes and Endocrinology points out that people mostly regain at least some of the weight they shed, a year after beginning a new, successful protocol that allows them to shed at least 5 percent of their weight. And though 5 percent doesn't seem like much, given peoples' propensity to be overweight in this modern world, it is frequently considered just enough to see improvement in weight-related health problems such as pre-diabetes and high blood pressure.

An estimated ten million Canadians actively engage on a diet on any given day of the week. Irrespective of what comprises the dieting, according to Dr.Daniel Bessesen of the University of Colorado, and Dr.Luc Van Gaal, University of Antwerp, once weight is dropped, the body tends to dial down energy expended at rest, undergoing alterations in insulin sensitivity favouring fat storage. "Long-term studies suggest that these changes are probably permanent", they caution.

Add to that the fact that not everyone is able to use anti-obesity drugs, and those who can benefit from their use must continue taking them if the intention is to keep weight down. "Weight increases gradually to the level seen with lifestyle changes alone", according to all studies of anti-obesity medications which conclude this outcome when the individual decides to stop taking the medication.

When leptin, the hormone known as an appetite-suppressant was discovered, scientists felt they had discovered the cure for obesity, until the revelatory understanding that many obese people are not deficient in the hormone, but rather are resistant to it.

After years of dismal failure with emerging drugs viewed as weight loss winners, but which later studies indicated were instead beginning to cause an epidemic of serious heart-valve problems in people with no known history of cardiac disease, the drugs were removed from the market, after millions of people had begun their use. Decades on, the pharmaceutical industry is returning anti-obesity drugs to the marketplace. Between the years 1975 and 2016, obesity has tripled among the general population.

It remains unknown why this has been occurring, although educated guesswork brings up less physical-oriented lifestyles and the normalization of the consumption of convenience, ultra-processed foods, along with the vast array of foods now available. While the common origins of the increasing rise in obesity is not yet understood, what medical science does acknowledge as fact is that once weight is gained, it becomes inordinately difficult to lose, and once lost, it then becomes even more difficult to maintain that loss.

To date, bariatric surgery is acknowledged as the most successful treatment for obesity, but many people cannot qualify for the surgery, or would prefer not opting for invasive surgery which has its own potential risks. And then there is the surgical wait list, of up to eight years. So the prospect of next-generation drug treatments for obesity has its obvious allure. Drugs of various types are beginning to emerge and tests carried out to determine their feasibility. Some of which have side effects that include nausea, constipation and diarrhea.

And then there is the recognition that the problem of obesity cannot be addressed by drugs alone even as two thirds of Canadians are recognized to be living with an overweight condition, or obesity. And for these people attempting to lose weight, the situation is that all anti-obesity drugs approved for use in Canada must be used in conjunction with a reduced-caloric diet and exercise plan. Some of the medications cost up to $4,000 annually, none paid for by provincial public drug benefit plans, whereas in the U.S. guidelines recommend such treatments only for those carrying a BMI of 30 or greater.

A group of girls wait for the start of a water aerobics class in Reeders, Pennsylvania. 

William Thomas Cain | Getty Images

Advances in Post-Heart Attack Heart Muscle Repair

"This injectable material is the first in the world prepared using human collagen."
"As a standalone therapy, we believe the rHCI gel performs better than any cell-based therapies or pharmacological treatment currently available, allowing for easier future translation to the clinic."
"The treatment works, in part, by increasing the number of cardiac muscle cells and blood capillaries in the tissue surrounding the damaged area. The gel also promotes the recruitment of more wound healing cells to the site of injury."
"We had to complete it [research study] many times because we couldn't believe it [the findings]."
"[The heart institute's BioEngineering and Therapeutic Solutions team [BEaTS] are hopeful their human collagen gel will one day lead to a recovery of heart function and prevent heart failure in humans, but more testing is required."
Dr.Emilio Alarcon, Scientist, Division of Cardiac Surgery, Director, Bio-nanomaterials Chemistry and Engineering Laboratory, University of Ottawa Heart Institute

"As people with damaged hearts are living longer, the incidence of heart failure is increasing. Therefore, a treatment capable of recovering cardiac function and preventing heart failure would have a tremendous health and societal impact worldwide."
"The therapy developed here in Ottawa by the BEaTS team is a promising approach to accomplishing this."
Dr. Marc Ruel, Division Head of Cardiac Surgery at the UOHI

Gordon Keller Lab. Heart cells beating in a culture dish

Roughly ten percent of people experiencing a heart attack [myocardial infarction] will see scarring and thickening of the heart wall developing, a situation that can lead to heart failure. The development is costly to treat and there is a high mortality rate attached to the condition.

Added to which people living away from urban areas, remote from health care, along with individuals who fail to seek out immediate treatment or have no idea they've suffered a heart attack, are likelier than others to suffer heart muscle damage.

Within Canada an estimated 600,000 patients cope with managing advanced heart failure, with health-care costs amounting to over $2.8 billion annually. This is a situation compounded by the fact that with professional health care of the greatest quality available, people are living longer and inevitably the numbers of people being treated with advanced heart failure through therapeutic means will rise even while treatment cost will inevitably increase.

Any new protocols that aid in prolonging life and making the condition more manageable would be a huge assist in terms of quality of life for patients and in alleviating the burden somewhat on the health care system.

Dr. Alarcon and his colleagues at the Heart Institute have been absorbed for years in the concept of a remedial gel for heart patients post-heart attack. They had developed a gel containing human collagen able to repair damaged hearts in laboratory mice. Because of the startlingly positive results, they methodically and studiously repeated the study, to find that randomized, blinded results validated their aspirational success.

The five years spent dedicated to the project saw publication in the journal Nature Communications, with Dr. Alarcon and Dr. Erik Suuronen, a scientist in the Division of Cardiac Surgery, and director of its Biomaterials and Regeneration program, as lead authors. The injectable gel their research produced is now viewed as an unprecedented leap toward addressing cardiac muscle repair following a heart attack, with the use of the injectable material recognized as the first ever prepared with the use of human collagen.

The gel is designed for injection directly into patients' hearts to help heal damaged heart tissue following a heart attack. The research team feels the gel is a vast improvement over any other cell-based therapies or drug treatments reflecting current therapeutic protocols. The gel treatment, explained Dr. Alarcon, works through increasing the number of cardiac muscle cells and blood capillaries in the tissue surrounding damaged areas of the heart as the gel helps to produce greater numbers of wound-healing cells to promote repair.

Abstract: Despite the success of current therapies for acute myocardial infarction (MI), many patients still develop adverse cardiac remodeling and heart failure. With the growing prevalence of heart failure, a new therapy is needed that can prevent remodeling and support tissue repair. Herein, we report on injectable recombinant human collagen type I (rHCI) and type III (rHCIII) matrices for treating MI. Injecting rHCI or rHCIII matrices in mice during the late proliferative phase post-MI restores the myocardium’s mechanical properties and reduces scar size, but only the rHCI matrix maintains remote wall thickness and prevents heart enlargement. rHCI treatment increases cardiomyocyte and capillary numbers in the border zone and the presence of pro-wound healing macrophages in the ischemic area, while reducing the overall recruitment of bone marrow monocytes. Our findings show functional recovery post-MI using rHCI by promoting a healing environment, cardiomyocyte survival, and less pathological remodeling of the myocardium.   

Injectable human recombinant collagen matrices limit adverse remodeling and improve cardiac function after myocardial infarction   Nature Communications

Targeting Alzheimer's Disease

"It could be a game-changer for the field."
"It could be one of the first disease-modifying therapies approved for Alzheimer's disease."
"We need to continue these different approaches because we think that a treatment is potentially going to be complex."
Rebecca Edelmayer, director, scientific engagement, Alzheimer's Association

"[Patients receiving aducanumab experienced] significant benefits on measures of cognition and function such as memory, orientation and language."
"[There were benefits in daily living activities; conducting personal finances, performing household chores and travelling independently outside the home.]"
Biogen, pharmaceutical company

Photograph by Scott Eisen/Bloomberg

"The field was really pinning its hopes that aducanuma would be positive, would show results."
"It did call into question whether attacking amyloid at all was a viable strategy." 
"The challenge, of course, is to convince the FDA [Food and Drug Administration] that [despite one failed trial and the second promising] therefore these are believable [the drug feasibility study]."
Ronald Petersen, director, Mayo Clinic Alzheimer's Disease Research Center

"I really hope these new analyses pan out."

"I'm not surprised that a reanalysis of the data showed something positive. I do believe that there are going to be probably continued regulatory hurdles."

"[Additionally, the drug could be extremely expensive.]"

"The complicated aspect here is I would not be surprised if additional analyses, with larger [numbers], with higher doses, do show signals in either the overall population or subgroup analysis, but is that going to be enough for the FDA to approve this from a regulatory perspective? Would payers reimburse it? I don't know, but I hope so."
Dr. Richard Isaacson, director, Alzheimer's Prevention Clinic, Weill Cornell Medicine, New York

At the present time, it is known that roughly 5.6 million Americans age 65 and older have Alzheimer's disease, progressively shortening their quality of life and hastening death. That number is expected to increase to close to 14 million by the year 2050, according to the Alzheimer's Association, should new treatments fail to surface. Currently, the Food and Drug Administration has approved a handful of drugs capable of alleviating some of the disease symptoms, but the past 16 years has been a desert of promise, with no new drugs being approved.

Now, however, drugmaker Biogen has surprised the medical world, the world of drug investment, and members of the public alert to any new promises for the future of Alzheimer's treatment by announcing it plans to seek federal approval for the drug whose clinical trials had been halted, the treatment considered a failure. The revelation that one of the trials was seen to be effective, through a new analysis, has given new hope that aducanumab -- which targets a protein called amyloid beta which builds in the brain and is suspected to be the cause of Alzheimer's -- may become a lifesaver.

The antibody therapy has suddenly moved front and center in Biogen's plans for regulatory approval and production of the drug. A situation regarded so promising that the stock market saw Biogen's stock soar in response to the news. An independent monitoring board back in March had pronounced little hope of success with the use of the drug, resulting in huge disappointment of the expectations of the scientific community when earlier trials had appeared promising in their positive results.

Later analysis, including data gathered in the months following the monitoring board's analysis seemed to indicate that one of the trials had indeed met its primary goal, while the other had failed to. If approved, aducanumab is slated to be recognized as the first therapy capable of reducing the clinical decline of Alzheimer's disease, bolstering the theory that treatments that remove or reduce anyloid beta, which creates plaques associated with the disease, represents an effective approach.

Therapies that address inflammation, the immune system, blood vessels and synaptic cell health are other therapies now in clinical trial. It is the considered opinion of experts in the field that a combination of several therapies will eventually emerge to create an effective Alzheimer's treatment. It was revealed that fewer people had received the high dose of the drug for a sufficient period of time in the failed trial, whereas those people in a subset of the trial receiving higher doses had seen improvement in their condition.

"There’s no doubt that if this gets approved it will be a massive product. And to what end? The slope of the decline in cognition is going to be 20% slower. But no one’s saying you’re not going to decline, let alone that you’re going to really improve."
"It’s a relatively marginal effect. Yet this drug is going to be introduced into a population of families and patients who are desperate, and who are going to line up for these monthly intravenous infusions; are going to swamp the medical infrastructure of this country with demand for those infusions; are going to swamp the payer systems with the costs of those infusions."
"[The drug alone could cost the system $5 billion per year.] Is that the right incremental dollar of spending for the healthcare system? It’s a question you can’t help asking, because the industry’s being scrutinized."
"We can only assume that the company got a very clear steer from the agency [FDA]. You wonder how much this reflects the agency’s urgency about getting a treatment on the market for a catastrophic disease of the elderly that has otherwise next to no treatment options."
"Five to ten years ago this would have been just laughed out of the beltway. I think the agency has become much more, I would say, responsive to patients and flexible to industry."
"I think that there are no accidental associations between events and management changes. It’s hard to imagine how it has a particularly positive implication."
Geoffrey Porges, SVB Leerink analyst  

Expanding Medical Knowledge, Creating New Protocols

"The pancreas was considered a sterile organ until a couple [of] years ago."
"While past studies from our group have shown that bacteria travel from the gut to the pancreas, our new study is the first to confirm that fungi too make that trip, and that related fungal population changes promote tumor inception and growth."
Dr.George Miller, oncologist, New York University School of Medicine

"We have long known that Malassezia fungi -- generally found on the skin and scalp -- are responsible for dandruff and some forms of eczema, but recent studies have also linked them to skin and colorectal cancer."
"Our new findings add evidence that Malassezia is abundant in pancreatic tumors as well."
Deepak Saxena, PhD, professor, Basic Science and Craniofacial Biology, NYU College of Dentistry

"Moving forward, one goal for our team is to determine which species are most relevant to cancer, as doing so could guide future attempts to slow tumor growth with targeted antifungal medications, and to avert side effects."
Smruti Pushalkar, PhD, research scientist, NYU College of Dentistry

Some gut fungi may promote the development of pancreatic cancer, a new study finds.

In the United States this year alone, close to 57,000 people will be diagnosed with pancreatic cancer -- their outcome poor, as three-quarters of those diagnosed die within a year of diagnosis leaving only about one in ten to live longer than five years.  "This (new study) is an enormous opportunity for intervention and prevention, which is something we don't really have for pancreatic cancer", commented cancer researcher Dr.Christine Iacobuzio-Donahue, at Memorial Sloan Kettering in New York.

The new study she refers to, its results published in the journal Nature early this month, made the discovery that fungi is able to infiltrate deep into the pancreas, an internal bodily organ one of whose functions is to secrete digestive enzymes into the small intestine. The fungi was found to proliferate 3,000-fold compared with healthy tissue, in mice and human patients with pancreatic cancer. One particular fungus was recognized as responsible for inciting pancreatic tumours to grow.

This discovery surprised the researchers by their very presence and tremendous increase in numbers found in disease, though fungi have not been unknown to be present, simply not so deeply ingrained.
Research had revealed that some microorganisms like bacteria were able to infiltrate past a muscle separating the pancreas from the rest of the gut; the feeling was that fungi could possibly colonize the pancreas in the same manner.

Laboratory mice were fed a species of brewer's yeast colour-identified with a green fluorescent protein, by Dr. Miller and his study team. It became clear that the yeast had moved to the pancreas -- thanks to the revelation of the marker -- from the digestive tract in a matter of mere minutes. A genus of Basidiomycota called Malassezia, found on the skin and scalp of animals and humans, able to cause skin irritation and dandruff, was found to be most abundant.

 Malassezia, found on human skin surprised scientists. Science Source

The discovery was that Malassezia was present in extremely high numbers in samples from pancreatic cancer patients, not just abundant in mice that grew pancreatic tumours. When an antifungal drug was administered to the fungi in mice, it served to eradicate the fungi to keep tumours from developing. Tumours began growing once more when the treated mice once again received the yeast, serving as an indicator that the fungal cells were responsible for driving the growth of the tumours.

As vital as the genetic factors driving tumour growth, increasing scientific consensus has arisen that the factors in a tumour's "microenvironment" are just as important. Support or prevention of cancer growth relies on surrounding healthy tissue, immune cells, collagen and other fibres that hold the tumour. Fungal population in the pancreas may now be recognized as a valid biomarker for just who may be at risk for developing cancer, along with recognizing potential targets for future treatments.

Eating Out Tonight!

"Pancakes with syrup or cheeseburgers are never a health food, but it seems like The Cheesecake Factory, Chili's and other chains are trying to outdo each other to make them worse."
"Although the 2019 Xteme Eating winners are nutritional nightmares, plenty of other dishes are as bad or worse."
"The good news is that all chains with twenty or more outlets are now required to list calories on menus and menu boards, and expanded nutritional information upon request."
Lindsay Moyer, senior nutritionist, Center for Science in the Public Interest (CSPI)

Well, as questions go, this is rather naive, but who, shopping for a calorie-dense, nutrition-absent treat would be interested to begin with in scrutinizing that nutritional information? Unless they're feeling deliberately masochistic, that is. People are drawn to the pure and rather insane allure of over-sweetened, -salted, -oily taste and texture of these folksy gourmet delights, having shed a sense of guilt, and prepared to indulge and that's the truth of it.

It is rather mind-boggling, in actual fact, that three of the Cheesecake Factory's Cinnamon Roll Pancakes contain 2,040 calories'-worth of brown sugar, white flour, icing and syrup infused with butter. What a treat! Although anyone sitting down to this special breakfast/lunch/dinner-all-in-one special might wish to think hard and deep that the ingredients and the calories contained within are the equivalent of 11 Crispy Creme Original Glazed Doughnuts....

So then let's get down to the serious business of meat-on-a-bun. Would you prefer a variety of sliced processed meats or would you go for three McDonald's Triple Cheeseburgers along with an order of large fries, or might you be intrigued with its caloric equivalent at Chili's where you can order The Boss Burger, accompanied with fries and pickles. "Smoked brisket, rib meat, jalapeno-cheddar smoked sausage, bacon, cheddar, lettuce, tomato, house BBQ & house-made ranch. We.Dare.You."
Well, dare to be bold and do it often enough and you can join the prestigious ranks of the 70 percent of U.S. overweight adults, edging toward obesity. The choice, dear consumer, is yours, all yours!

And not to be outdone, there's an oversized sub at Jimmy John's Giant Gargantuan stuffed with luncheon meats; salami, capicola, turkey, roast beef and ham, along with provolone cheese, onion, lettuce, tomato, mayonnaise, oil and vinegar all stuffed into that sub whose 7,720 mg of sodium and saturated fat (29 g) is a guarantee you'll walk out of the experience feeling, um, full and smacking your greasy lips with satisfaction, wondering how you'll top that one when dinner rolls around, since you've just finished with lunch...?

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And if you're feeling really thirsty, how about giving a really great milkshake a try, and if you really like it, it can become a regular treat. That's where Sonic's Oreo Peanut Butter Master Shake takes a bow and a curtsy. It has a day's value of added sugar (62 g) for a large shake -- about a litre at 32 oz -- containing enough saturated fat (48 g) to represent two and a half days' worth. But think about how delish it'll taste to the appreciative tongue, with its topping of whipped cream, and a bright, red cherry.

Oh, there's more, there's always more as specialty purveyors of peoples' favourite taste sensations do public relations adverts and study people's tastes and psychological frailties over denying themselves the unalloyed sensuous pleasure of eating the forbidden; processed food in excess of common sense, forgetting moderation in the temptation to feel good because let's face it, eating is such a pleasure, all the more so when taste-bud-sensational cautions of salt, sugar and fat intake beyond the sensible will inevitably result in excess weight, all he more so as we grow older and no more wiser.

And who can resist waffles? And then there are fascinating combinations most people would likely never think of. Take that old favourite chicken, and pair it with waffles and you've got -- wait for it -- “We’re bringing in better ingredients and the best chefs to craft craveability that you’ll only find at Dave & Buster’s", boasts the arcade and sports bar’s menu of their Chicken & Waffle Sliders.  In which white flour, sugar and "better" ingredients produce fried chicken, bacon, mini-Belgian waffles, maple syrup and tater tots to the value of only 2,340 calories! Its less preciously- tantalizing equivalent? 8 Eggo waffles, 8 Jimmy Dean pork sausage patties, with 1/2 cup of maple syrup. Yum!

Keeping Fit, Improving Balance, Losing Weight, Achieving Cardiovascular Goals -- Climb Those Stairs!

"By raising our heart rate, stair climbing helps protect against high blood pressure, weight gain and clogged arteries. This lowers the risk of developing chronic conditions such as diabetes, heart disease, vascular dementia and even some cancers."
"Stair climbing also exercises our bones and muscles, improving strength, bone density and muscle tone. This is especially important for women in sedentary office jobs as they have a significantly higher osteoporosis risk than men."
"Incidental physical activities like stair climbing are also associated with improved mental health.They cause our bodies to release endorphins, the so-called feel-good hormones. They also provide time think and reflect - key factors in managing everyday stress and tensions."
StepJockey

 If there are stairs to climb at the workplace, take them instead of an elevator or escalator. You'll be exercising your body and clearing your mind and your brain will like it, too. If you live in a two-story home with a basement, that's two sets of stairs right there, where you live. If you get out recreationally often and climb hills you'll be promoting your own superior health outcomes. Just shake the lazy mentality off its perch on your shoulders and get going.

Think of it as a workout, because that is what it is, or can be, if you take it seriously enough. Taking the stairs option even casually, however, workout aside, is a good idea. The Harvard Alumni Health study issued a report pointing to their conclusion that climbing ten to nineteen flights weekly (two to four flights each day) has the effect of reducing mortality risk. How's that for a bonus?

www.active.com

That is no one-off study; quite a large number of other studies indicate that consistently selecting stairs can improve cardiovascular fitness, balance, gait, blood pressure, glucose, cholesterol and of course, weight loss. The lower body's muscles spring into action both ascending and descending stairs while the heart works hard on the ascent, sufficiently so to qualify as equal to a vigorous intensity workout; descending a moderate intensity action.

When you're in the act of climbing several flights of stairs in one go, your body's reaction of heavy legs and breathlessness is a more-than-ample signal that you're exercising aerobically. A study of current research results points to 30 to 160 minutes of serious stair-climbing on a weekly basis extended from eight to 12 weeks boosts cardiovascular fitness.

A research team from McMaster University had 24 university students perform a series of short, fast stair intervals with students climbing three flights of stairs (60 steps) three times daily and a one to four hour recovery between bouts. This protocol was continued three days weekly for a period of six weeks with instructions to climb the stairs one step at a time quickly as possible, and if required, using the railing. Aerobic fitness in the stair-climbers was boosted by five percent.

"Interestingly, a study from Taiwan in Medicine & Science in Sports & Exercise in 2017 found that walking down stairs can be even more beneficial than going up in some ways. It had 30 healthy but sedentary obese women (ages 60 to 82) engage in progressive aerobic training on five flights of stairs (110 steps), either by going only up or only down (they took an elevator to go the other direction), twice a week for 12 weeks, gradually increasing the number of flights per week. Both groups benefited, but while women going up stairs got more of an aerobic workout, those going down stairs had greater improvements in blood pressure, blood cholesterol, blood sugar, bone density, and functional fitness."
Berkeley Wellness

A McMaster research team on another occasion involved two sets of subjects; one group performing 20-second episodes of stair-climbing (three to four storeys) three times, two minutes' recovery between each interval, while the second group did 60-second  bouts repeatedly ascending and descending either one or two flights of stairs three times  and with 60 seconds recovery between intervals. Each group did their workouts for six weeks, three days weekly.

The 20-second and 60-second interval workouts came in with similar heart rate response and fitness gains. Study subjects however, claimed the quick changes in direction in the 60-second intervals continually climbing up and down for two fights destabilized them and they voiced their preference for the 20-second interval of stair-climbing. Both studies concluded that for optimal results this simple time-efficient workout makes reaching fitness goals achievable.

The ability to go up and down stairs quickly and with confidence is a task worthy of preserving. Allen McInnis / Montreal Gazette