By Dov Michaeli MD, Ph.D

I used to be one of those amateur opinionators who predicted the end of Homo sapiens, especially the sapiens part, as a result of the corrosive effect the Internet on our fragile brain. After all, wouldn’t you guess that the fact that one can get in one fell Google an answer to a crossword puzzle entry or to a difficult diagnosis that had eluded the best diagnosticians in the hospital – would simply make our brain even lazier than it is wired to be? On the other side of the debate were those who argued that the Internet teaches us to think and act in new and unconventional ways.

Mea Culpa.

I was wrong. Investigators at UCLA discovered that daily one hour of surfing the web actually increases the IQ, and improves the memory of adults.

The investigators compared the brain activity of participants of 55-76 years of age that rarely used the internet with that of people who use the internet daily. The subjects had to perform searches on the internet for an hour a day. Five days later areas of the prefrontal cortex, the region that is in charge of making decisions and integrating complex information arriving from different areas of the brain, were significantly more active. According to Gary Small, leader of the research team and professor of Psychiatry, these areas were quite inactive at the beginning of the experiment. But, five days later these areas were as active in the group that had not been active Internet users as in the group of regular internet users. This is one more demonstration of how fast the brain can change and improve –another instance of what is called “brain plasticity”. The research adds a neurobiological basis to the observation that average IQ has been continuously increasing since the advent of the digital culture. The capacity to process information quickly and to perform several tasks in parallel without errors (multitasking), has Improved as well. Even boring and repetitive tasks improved decision making. The selectivity inherent in cleaning up incoming mail on a daily basis helped the development of better skills of going over large quantities of information rapidly and deciding what was important and what was not. 

So if they are so smart, how come they are so…

But not everything is so wonderful in the new Wide World of Digital. According to Small “digital natives”, those who were born into the computerized and aggregated information age and who regard these technologies as a natural part of their world, tend to have lower listening skills as compared to the “digital immigrants”. Their social skills are inferior to those of the digital troglodytes. “Today’s youth can spend eight hours or longer at the computer screen exposing their brain to the digital technology. But the time spent watching TV or surfing the web is time taken away from what is required to create and fix the neuronal connections required for face to face communication.

Small calls it “the brain gap” between young and adults. “What use to be a simple generation gap has become a huge chasm, which has led to two different cultures.  

My Take

1. This research confirms and lends biological basis to the intuitive observations that ‘something is different about the young generation’. Sociologists and instant commentators in the media labeled them generation X, generation Y, the “me” generation, and assorted other non-informative names. The “digital generation” rings more substantive.
2. The remedy for the afflictions of an all-digital world is balance. Kids should play on the street, families should have dinner together and talk to each other –these are simple, non-technological things that we digital immigrants used to do as a matter of course but now seem as relics of a quaint distant past.
3. Last but not least, I can’t resist a smug smile: I knew we were better.



A few days ago I received in the mail an unexpected package from Amazon. Not having had ordered anything from them, I was tempted for a minute to return it unopened, but then curiosity got the better of me –and what a surprise. It was a new book by my friend Lenny Karpman, a food writer and connoisseur about… chicken soup (“First, You Boil a Chicken”, available from Amazon). And what a gem it is!

But I am not here to promote a book. What I found strange was the physical reaction the title evoked: I literally smelled, heard and saw my mother standing next to a piping hot, steaming chicken soup with bubbling sounds coming out of the pot in the kitchen of my childhood. How can this be explained?

We all know that a smell can instantly transport us back to childhood or evoke pleasant or unpleasant memories, but now researchers in Israel believe they have found the reason why. In an experiment, scientists from the Weizmann Institute of Science in Rehovot led by graduate student Yaara Yeshurun tested a number of volunteers to see if their initial association of a smell with an experience would leave a unique and lasting impression on the brain. In a special smell laboratory, volunteers were shown images of 60 visual objects - including chairs and pencils (objects that are not normally associated with any smells), and at the same time were presented with either a pleasant or an unpleasant odor including pear, fungus, and dead fish, generated by a machine called an olfactometer.

The subjects were then placed in a functional magnetic resonance imaging (fMRI) scanner and asked to recall the smells associated with each image. The entire test was repeated 90 minutes later with the same images but different odors.

The scientists discovered that after a week, even if the volunteer recalled both odors equally well (both the pleasant and unpleasant), the first association revealed noticeably activated levels of brain activity in the hippocampus and the amygdala, areas of the brain associated with memory, learning and emotion.

The effect was so clearly defined that the researchers were able to predict how well a volunteer recalled smells eight days later, based on their first fMRI scans. They also found that unpleasant odors made the biggest first impression.

The experiment was also conducted using sounds rather than smell, but the scientists discovered that sounds did not arouse a similar distinctive first-time pattern of activity. Their research was published in the latest issue of Current Biology.

In her research article, Yeshurun says it makes good sense to remember unpleasant memories as a kind of evolutionary "risk management". "[It] may represent a potential adaptive mechanism considering the potential cost of failing to learn a first negative association and the potential benefit of a malleable first positive association," she and her colleagues write.

OK, I accept the conclusion that olfactory memories persist and that they quite logically confer an evolutionary advantage. But son et lumiere associated with the smell?

The paper does not deal with this question. But here is what we already know: the olfactory, auditory and visual areas in the brain are extensively interconnected. In fact, there is also an area where all those stimuli are integrated into a coherent context.

Can this be exploited clinically? Could psychiatrists of the future evoke long forgotten memories with smells, or sounds, or pictures in treating phobias or PTSD? I believe the answer is yes, and not in the distant future.

Oh, yes -about that chicken soup smell. Get the book and go to the section of your geographic, or ethnic, origin. Read it and smell the fragrance. Highly recommended.

Help me out here.  How is blowing up newly minted doctors in a third world country --desperate for doctors -- advancing the Somali culture/society/well-being???  Who are these people who blow up folks who could provide essential services to their own countrymen/women?  

The Islamist group Al-Shabaab is being blamed by the president of Somalia for the attack.  He says the suicide bomber had a beard and shreds of a hijab -- evidently he dressed as a woman to commit this unconscionable attack.

Somali's speak out.  Muslims speak out.  Doctors speak out.  This madness has got to stop.

Patricia Salber

The Doctor Weighs In

Until now, non-health care business has been noticeably absent from the health care reform proceedings, and quiet about the bill's impacts on their management of employee benefits, on cost, and on the larger issues of competitiveness globally. Where have the voices been of the powerful business leaders who will pick up much of the tab?

Keep in mind that, at this point, health care reform has been a series of power plays between Congress and the health care industry (meaning the professionals, firms and associations representing health care's four major sectors: the supply chain, HIT, care delivery and insurance/finance).

Until now, the health care industry - those who seek dollars - has dominated, lobbying Congress and contributing enormous sums to election campaign coffers to make sure that the legislation doesn't impede health care profiteering and sends new funds their way. Meanwhile it has held its breath, apparently hoping that other interests with clout won't notice. As the bills come down to the wire, the air waves have NOT burned with cautionary and righteously indignant health care industry messages opposing them. That's because organizations in the health industry are reasonably certain they've won. They have been sitting tight until the deals are done.

And with good reason. As they stand now, the reform bills are very generous to the health care industry, facilitating, through mandate and/or subsidy, millions of new customers but, as we've recently pointed out, doing pathetically little to rectify the health care crisis' structural drivers. For example, the health plan sector can raise rates without restraint, and a significant chunk of Medicare dollars will be transferred to private sector control. The biotech industry gets a 12 year moratorium on generic competition. With only token progress away from fee-for-service reimbursement and toward primary care re-empowerment, the system will continue to make specialist excesses lucrative. The American Medical Association (AMA) and Medical Group Management Association (MGMA) couldn't be more enthusiastic, though both are now campaigning for H.R. 3961, which would eliminate the 21.2% drop in Medicare physician reimbursements scheduled to go into effect January 1, 2010. There are many more examples.

Commercial purchasers have waited to see how all this would play out. But now they're stirring, and not a moment too soon. Non-health care business leaders finally appear to be mobilizing against the weak cost control provisions of the current proposals.

What is needed now is an orchestrated, mobilized, highly visible campaign effort that features the faces and voices of well-known American CEOs, and that leverages the full force of business' leadership across industries, not just for their own interests, but for those of all Americans. The places to start are in the structural areas we and others have recently discussed: primary care, fee-for-service reimbursement and cost/quality performance transparency. Properly implemented, reforms in these approaches throughout health care could have profoundly positive impacts on both cost and quality, empowering the market to make health care far more affordable for businesses and working families.

It is possible that the entire health care reform process just changed tone and direction. If it did not, then we're no worse off than before. But if it did, then the ramifications for how American policy works - not just for health care but for all our issues - could have just entered a new and profoundly important paradigm.

Brian Klepper and David C. Kibbe write together on health care market dynamics, health IT, innovation and policy.

By Dov Michaeli MD, Ph.D

Art history has always fascinated me. It encompasses the history of art since essentially the beginning of intelligent Homo sapiens. The astounding art in the Chauvet cave in France dates back to 32,000 years ago! Think of it: these ancient people manufactured their own pigments and were painting before they could communicate through writing. A painting, any painting, is a puzzle. What purpose did the paintings serve? What were they trying to convey? Art criticism is trying to decipher just that. What did the artist mean? Is she successful in evoking the desired emotion?

To me, one of the fascinating aspects of Picasso’s work is his depiction of the women in his life. I read and re-read works of art criticism, trying to understand the images of women pulled and gouged into tortured shapes, women cut in bits and reconfigured on the canvas. Yes, I intellectually know that he had a stormy relationship with his Russian ballet dancer wife, Olga Khokhlova. But why do the paintings of her image evoke such a viscerally uncomfortable feeling? Is it the fact that her nose, painted in two perspectives is reminiscent of a pig's nose? Or that the unnatuarally long fingers and sharp nails are talon-like? Is it  why are paintings of Dora Marr, his mistress and accomplished photographer, resemble more a human-like monster than a warm-blooded human being?

 A Possible Answer?

A recent paper in the Proceeding of the National Academy of Sciences titled Monkey visual behavior falls into the uncanny valley (October 12, 2009) struck a Aha! bell.

As the authors note, “it is natural to assume that, as synthetic agents (e.g. androids or computer-animated characters) come closer to resembling humans, they will be more likely to elicit behavioral responses similar to those elicited by real humans (namely, empathy; my addition). However, this intuition is only true up to a point. Increased realism does not necessarily lead to increased acceptance.”

And here is the amazing observation: “If agents become too realistic, people find them emotionally unsettling. This feeling of eeriness is known as the “uncanny valley” effect and is symptomatic of entities that elicit the concept of a human, but do not meet all the requirements of being one”.

We know it from our own experience. Haven’t you found it almost irresistible to avert your gaze from a person whose face has become horribly deformed by disease or accident? Would you feel comfortable touching his or her face?

These unsettling emotions are thought to have an evolutionary origin, but no evidence for that hypothesis have been available –that is, until now.

Would monkeys, for instance have this “uncanny valley” when shown pictures of monkeys that resemble, but not quite, a real monkey? To test their preference, researchers showed macaque monkeys real pictures, digital caricatures and realistic reconstructions of other monkey faces. To the latter, the macaques repeatedly averted their eyes.

“The visual behavior of the monkeys falls into the uncanny valley just the same as human visual behavior,” wrote Princeton University evolutionary biologists Shawn Steckinfinger and Asif Ghazanfar. The “uncanny valley” was identified in 1970 by Japanese roboticist Masahito Mori, who noticed that people presented with likenesses of increasing realism respond with increasing empathy, right up to the point where the likenesses are almost real. At that point, people are repulsed. The sudden dip in graphs describing their response gave the phenomenon its name.

Did Picasso know about the “uncanny valley”?

I am pretty sure he didn’t. But what I do suspect is that his genius was not restricted to painterly matters –he was intuitively a master of the human psyche. Picasso could be astoundingly brutal, to friends, lovers, even complete strangers. 'Women are machines for suffering," Picasso told his mistress Françoise Gilot in 1943. Indeed, as they embarked on their nine-year affair, the 61-year-old artist warned the 21-year-old student: "For me there are only two kinds of women, goddesses and doormats". Of the seven most important women in Picasso's life, two killed themselves and two went mad. Another died of natural causes only four years into their relationship. So is it far-fetched to suspect that the great wizard manipulated, may be unconsciously, us, merely mortal admirers of his paintings, into feelings of unease, even hostility, toward the women he brutalized emotionally in the service of his art?

So you thought you’ve heard enough about the deep fissures in our body politic; a map that is colored red for Republican states (last I checked this color connoted Socialism, God forbid) and blue for Democratic states (blue-blood Democrats? The ultimate oxymoron; who is the moron who devised this system, anyway?). Or noisy demonstrations against the “public option” (and don’t touch ‘my Medicare’ you dirty Socialists!) or angry commentators on MSNBC (does Keith Olbermann ever smile? Lighten up dude, you won!) who’d rather see no health care reform at all than cede one iota to the malevolent opposition. Well, scientists finally found what is at the root of this divide: TESTOSTERONE!

Background evidence

 As if we didn’t suspect that something primeval must be underlying the differences between D’s and R’s. Consider:

• More D’s are vegetarians, and conversely more veggies are D’s.
• Psychological studies have shown that D’s tend to show more empathy than R’s.
• Likewise for tendency to altruism.
• Maybe somewhat unrelated, but more college graduates are D’s, more professors are D’s, more journalists are D’s, and according to Pat Buchanan/Spiro Agnew D’s are “nabobs of negativism”, or simply put –a bunch of egghead wimps.

It wouldn’t surprise me if some anthropologist came upon skeletal remains which clearly demonstrated that ancient R’s were hunters and ancient D’s were gatherers. That’s no joke; just consider: anthropologists do tell us that men were the hunters and women were the gatherers. And guess what: more men are R’s and more women are D’s; ergo it begs the conclusion that R is likely to have been a hunter, D - a gatherer. Do you suspect that testosterone may have something to do with it?

Yes, it does!

An article titled “Dominance, Politics, and Physiology: Voters’ Testosterone Changes on the Night of the 2008 United States Presidential Election.” By Steven J. Stanton, Jacinta C. Beehner, Ekjyot K. Saini, Cynthia M. Kuhn, Kevin S. LaBar.was published in PLoS ONE, October 21, 2009. Mind you, PLoS ONE (Public Library of Science) is a first tier scientific journal: it is peer reviewed, highly regarded for the quality of its papers, and as the name implies – does not accept advertisement of any sort so as to safeguard its independence of any commercial or political bias. Now that I biased you sufficiently to accept the findings, read on.

The study investigated voters' testosterone responses to the outcome of the 2008 United States Presidential election. They note that “Dominance contests are a critical component of determining the leadership of social hierarchies across a wide range of species. In modern human societies, this dominance contest can take the form of a democratic election. Across mammalian species, testosterone is critically linked to dominance competition for hierarchical advancement in males. When males win a dominance contest, their testosterone levels rise or remain stable to resist a circadian decline, and when they lose, their testosterone levels fall”. A word of interpretation: “remain stable to resist a circadian decline” means an actual rise, in the same way that stable temperature in the morning, when it is supposed to drop from the evening levels, is in effect a rise.

Testosterone Levels: 183 participants provided multiple saliva samples before and after the winner was announced on Election Night.

Right wing Authoritarianism: The researchers also measured individuals' endorsement of authoritarian ideals using the right-wing authoritarianism (RWA) scale. The RWA scale includes items assaying individuals' values on issues such as religion, homosexuality, abortion, marriage, feminism, moral tradition, and strong leadership.

 The results show that male Barack Obama voters (winners) had stable post-outcome testosterone levels, whereas testosterone levels dropped in male John McCain and Robert Barr voters (losers). There were no significant effects in female voters.

The results also showed a high correlation between the RWA (right  wing authoritarianism) scale and declared political affiliation.

 In a typically professional understatement, the authors conclude: “The findings indicate that male voters exhibit biological responses to the realignment of a country's dominance hierarchy as if they participated in an interpersonal dominance contest”.

What does it all mean?

It may have many political/societal implications, but some of them are almost self evident.

• The losing party is in a funk, especially its male members, no pun intended.
• As many psychological studies have shown, the normative response to loss is final acceptance. But a non-normative (i.e. pathological) response could be denial, or worse – rage. Any evidence for that on recent TV images? Did the Secret Service take notice?
• Societal trends in the U.S. tend toward the less authoritarian, more inclusive attitudes. Did the GOP leaders take notice?

And finally: isn’t science fun when you are a D, and sort of a drag when you are an R? Just witness the difference in attitude toward science between W’s White House and O's.

By Dov Michaeli MD, Ph.D

We all have memories; some are pleasant, some less so, some have emotional content (my first date), some have none (I am not going to dip my hand in boiling water because I got scalded when I was young and didn’t listen to my mom). But did it ever occur to you that we really don’t know how we remember? Yes, I know, everybody knows that there is a special area in the brain called the hippocampus where memories reside. But that only tells us about the anatomical location of memories, not how they are made. A recent amazing experiment, using our distant cousin the fruit fly took a first stab at this problem. The results of the Oxford University-led study are published in the journal Cell. 

Scientists have used light to program the memories of fruit flies. Think about it: light to program memories!  The research team genetically engineered the fruit flies so that a small set of nerve cells in the brains would ‘fire’ in response to a flash of laser light. This showed which cells are involved in how a fruit fly learns and remembers what to avoid, and offers an exciting new opportunity to investigate how memories are formed.

‘Remote-controlling these cells and turning them on using light creates an illusion in the brain of the fly that it is experiencing something bad. The fly learns from the “mistake” it never really made and improves its actions the next time,’ explains Professor Gero Miesenböck of the Department of Physiology, Anatomy and Genetics at Oxford University, who led the work.

The Oxford scientists, with colleagues at the University of Virginia, Charlottesville, demonstrated that they could use flashes of laser light to train flies to dislike a certain odor.

They tracked the flies using a video camera as they moved around a small chamber while two different odors were fed into the chamber from either end. They found that they could implant a lasting preference for one odor over the other by remotely activating a specific set of brain cells each time a fly strayed into a particular odor. Using this method, the researchers were able to pinpoint the precise nerve cells that are responsible for telling the flies that they’ve done wrong, narrowing down the search from the 100,000 cells in the brain of a fruit fly to a set of just 12 neurons.

This puts them in position to follow this up and start to characterize the process by which memories are formed and organized.

 Surprisingly, the source of these signals is in a limited number of cells – just twelve. These cells send the signals that train the fly to associate the odor with something bad, so wherever their signals go must be the seat of memory.They can now follow this up and start to characterize the process by which memories are formed and organized.

While this work has been done in fruit flies, general lessons about how actions are learned and memories are stored should hold true for humans.

What is the relevance of fruit flies memories to our infinitely more complex brain? Biology teaches us that fundamental mechanisms tend to be conserved. Learning about the storage of memories from brain cells in flies should tell us a lot about how they are stored in humans. Professor Miesenböck has pioneered this method of genetic engineering to remote control the action of specific cells within tissues, or whole organisms like worms, fruit flies, fish and mice, using light from the outside. These efforts have given rise to a new field sometimes called ‘optogenetics’, to indicate that sensitivity to light is encoded genetically.

 As the ability to write memories directly to the brains of fruit flies demonstrates, optogenetic techniques have particular power in neuroscience. Why?

Because we are no longer just passive observers of processes in the brain. In the past, neuroscientists had to be content with recording the chatter of brain cells and trying to infer what it all meant. The ability to talk back and influence behavior directly is a game changer.

But do you get the vaguely discomfiting feeling as I do, that such techniques in the wrong hands can be abused? After all, genetically engineering human beings is already in clinical trials as a way to treat certain diseases. Once we master the technique, what would prevent a rogue scientist or a malevolent government from using it to control thoughts and behavior by shining a laser light? Sounds like the stuff sci fi is made of. Am I becoming a paranoid conspiracy theorist? At the dawn of the molecular biology era concerned scientists saw the potential for mischief in the misuse of DNA genetic engineering. They convened in Asilomar, a conference site in Northern California, and hammered out a code of scientific conduct that has served scientists and society exceedingly well. It is time for neuroscientists to do the same.

Check this out:  Piano Stairs

By Dov Michaeli MD, Ph.D

Go to the ant, you sluggard; consider its ways and be wise!

King Solomon, Proverbs 6:6

An item in the October 12 issue of Current Biology is really cool. Scientists from the University of Arizona and Brandeis University described the first known vegetarian spider. In fact, the aforementioned creature has gone a step further: he is a vegan, eating only uncooked veggies. They discovered this species (B.kiplingi) in Mexico and Costa Rica. But that's not all - the story gets even more interesting.

The Evolution of Vegetarianism

Spiders normally spin webs to better catch unwary insects for their daily “bread”. But this spider had a great insight: acacia plants are normally swarming with ants; this is a well-known example of mutualism — the insects provide protection for the plant and in return the acacia produces nutritious leaf tips (Beltian bodies, for the more scientifically inclined) for the ants to eat. So what does our clever spider do? He learned to jump to avoid the ants, and when the opportunity presents itself –he feeds on those very nutritious leaf tips. Speaking of rigorous science, the authors documented that this is indeed the major nutritional source of this veggie-spider by analyzing the chemical composition of its body, and demonstrating that its source is none other than those Beltian bodies.

And now for the final surprise: the males of B.kiplingi take care and protect its young larval offspring, a phenomenon unheard of in the spider world.

More Questions

Like every good piece of research, this one raises more questions than answers. Here are a few:

1. How did this adaptation occur? Enzymes required to digest an insect meal are quite different form the ones required for digesting plant material. Obviously, mutations had to occur. Did they change the function of pre-existing digestive enzymes, or did they occur in non-digestive proteins acquiring the function of plant-digesting enzymes?If it turns out to be the latter it would be absolutely astounding. But I wouldn't dismiss anything concocted by this non-conformist spider.
2. Is there a functional relationship between the unconventional diet and the equally unconventional behavioral change of rearing the young? Did one inevitably lead to the other? And if so, what came first, the diet or the “socially conscious” behavior?
3. Finally, like everything else nowadays, we should consider the profound political implications. Numerous studies have demonstrated that liberals are more likely than conservatives to be vegeterians, while conservatives are more prone to feast on red meat. Furthermore, progressive fathers assume more responsibility in performing child rearing and other domestic duties. And finally, a respectable poll showed that more educated people tend to vote Democratic rather than Republican. Caveat: these are only "tendencies", not absolute distinctions. Having said that, is it possible that the political equivalent of "women are from Venus, men are from Mars" is "progressives eat veggies, conservatives eat bugs"?

I think I’d better quit now before I incur the wrath some fire-breathing, flesh-eating commentators.    

Doctors join fight against obesity

A patient's weight is often the white elephant in the examining room. Both patient and doctor know it's a problem, but often neither party wants to talk about it, says internist William Bestermann Jr., 62, medical director of a cardiovascular treatment program for the Holston Medical Group in Kingsport, Tenn.

But "if doctors are serious about keeping patients from having heart attacks and strokes, they have to have this conversation, and they have to help their patients lose weight," he says.

Bestermann is helping develop recommendations for physicians on how to guide and treat overweight patients on a committee for the STOP Obesity Alliance, a coalition of professional groups, businesses, unions, insurers and health care providers whose goal is to figure out how to best attack obesity.

"He has been a phenomenal advocate to convince patients and physicians that they are a team attacking this problem together," says Christine Ferguson, director of the alliance.

Debra Horne, 52, of Dungannon, Va., says Bestermann "gave me my life back" by addressing her weight.

In July 2007, she went to see him for the first time. "I'll never forget that day," she says. "Dr. Bestermann walked into the examining room and sat down and introduced himself. He said, 'I see you have a lot of medical problems,' but he never mentioned my weight."

At the time, Horne, who is 5-foot-9, weighed 298 pounds and had type 2 diabetes, high blood pressure, high cholesterol and high triglycerides. She had suffered from depression. She had had foot and back surgeries and was getting around on a motorized scooter. When she got down on the floor to play with her grandchildren, she couldn't get back up on her own.

Bestermann asked Horne to read The South Beach Diet. "He said: 'I'm not asking you to go on a diet or lose weight. I just want you to get the knowledge that is in there,'" she says.  (click to continue)

I must admit that when I read about Prof. Bernard Gesch’s experiment on the relation between nutrition and violence, I had a mental reaction that probably approximated something like an intellectual sneer.

Bernard Gesch is a psychologist and an Oxford University professor, an impressive credential.Bernard Gesch. Senior Research Scientist His study was a double-blind, placebo-controlled, randomized trial, the gold standard in biological and clinical research. So what’s there not to like? I would say right off: a deep suspicion of nutritional claims, most of them either products of junk science, or no pretense of science at all –just claims.

Polmont Prison

The Experiment

In 2002 Gesh and colleagues published a report in the July issue of British Journal of Psychiatry about an experiment conducted in a prison in Aylesbury, England. In a double-blind, placebo-controlled, randomized experiment, Gesch et al. recruited 231 young adult prisoners, assigning half to receive dietary supplements and the other half to receive a placebo. The placebo and active-treatment groups were matched according to their number of disciplinary incidents and their progress through the prison system. There were no significant differences between the two groups in IQ, verbal ability, anger, anxiety, or depression.

Subjects remained on the supplements, which contained vitamins, minerals, and essential fatty acids, for an average of 142 days. Compared to the placebo group, the researchers report, prisoners taking the active supplements committed an average of 26.3 percent fewer offenses. Compared to baseline rates, there was a 35.1 percent reduction in offenses in the supplemented group. "The greatest reduction occurred for the most serious incidents including violence," the researchers note, with a 37 percent drop seen in such incidents. No side effects were seen in subjects taking the supplements.

This is truly impressive! And believable. The methodology of the study is beyond reproach, the statistical analysis is persuasive. And the societal implications are profound.

The September 25 2009 issue of Science reports that a much larger and more detailed study is now under way in one of the most violent prison in the U.K (Polmont, Scotland). The 3-year trial, which started this spring, includes blood chemistry analysis and a battery of computer-based behavioral and cognitive tests designed to address the question that the earlier study could not: If a balanced diet does stem violence, how exactly does it do so?

Other studies have shown a connection between diet and violence, the latest one in the Dutch prison system. Similar findings were reported by Richard Carlton et al. (Alternative Therapies, Vol. 6, No. 3, May 2000, pp. 85-91.) who found that supplements improved mood, behavior, and school performance in learning disabled children. And to close the loop: several studies have shown a connection between learning disabilities and violent behavior.

What can be done right now?

So what are we waiting for? Here is an inexpensive and scientifically- based intervention that promises to deal with a scourge afflicting our society. Anybody who watched the clip of the young student beaten to death by violent gang members on the streets of Chicago while onlookers did not interfere (and haven’t come forward to give evidence) cannot escape but wonder: why?! And why not try something as inexpensive and as promising as dietary supplements in our prisons and schools?

Part of the answer, criminologists and researchers say, is political: we have an ethos of “get tough” on prisoners. I can hear the hue and cry in certain circles that we are coddling criminals.

Of course this is not a panacea. Of course there are deep and complex causes of violence in America. But if there is a real chance of mitigating the problem, if we could save even a few lives –why not try it now?

There was a rabble rouser in the house at The Palm Beach County Medical Society’s “Future of Medicine” summit held at The Scripps Research Institute in Jupiter on Friday.

But it wasn’t featured speaker Dr. Jeremy Lazarus, who was there from Colorado to explain the American Medical Association’s unprecedented support for health reform.

The radical in the auditorium was Brian Klepper, a health care consultant whose firm is pushing for higher fees for primary care doctors, lower fees for specialists, and publication of physicians’
outcome data based on Medicare information – positions in conflict with the AMA’s official stance.

Klepper argued convincingly that nothing would improve health outcomes and lower costs more quickly than to make public doctors’ names alongside their success rates. That information exists in the federal Medicare database. It also exists in the computers of Cigna, Aetna and United Healthcare. But the public can’t see it.

Under the current system, the same knee surgery can cost between $2,727 or $9,383 depending on the doctor, yet the amount spent has little or no bearing on the quality of the outcome, Klepper argued.

Publishing doctors’ outcomes has been done by one health system in Kentucky, he said, and that system saw costs curtailed by 30 percent in two years.

“Those with the best outcomes gloated, and those with the worst outcomes got on the phones and asked ‘hey, what are you doing for those patients,’” Klepper said.

“If Medicare physician data were released, we would easily be able to see how doctors performed compared to their peers,” he said.

Klepper slapped the AMA for its protectionist stance on Medicare reimbursements to specialists. Primary care doctors are paid a fraction of what specialists are paid, yet they have the best chance of changing the behaviors - overeating, smoking, lack of exercise, drug abuse – that are most likely to lead to costly chronic diseases, he said.

Given that health care and other special interest lobbyists have showered Congressional leaders with half a billion dollars to influence what’s in the health reform bill, Klepper predicted that it would ultimately flop when it came to controlling spiraling health costs.

Ultimately, Klepper said, it will be large employers who force the system to change. And they’ve got the data to make sure it happens.

Let's break it down into manageable bites: 

• Osteo means bone. 
• Odonto refers to teeth. 
• Kerato in this case refers to the cornea. 
• And prosthesis according to Wikipedia is "an artificial extension that replaces a missing body part." 

The procedure is used for people who have lost their sight because of corneal scarring. 

Here is what happens:

1.  The person who has a scarred cornea has one of their canine (eye) teeth removed together with the underlying bone (thus, osteo-odonto). 

2.  The operator drills a hole in the tooth and inserts a cylindrical artificial lens.

3.  The tooth, with the lens, is inserted under the patient's skin for a number of weeks so that it can "bio-integrate" - encourage the patient's tissue ito grow into the synthetic cornea.

4.  The surface of the damaged eye is then cleaned and repaired using skin from inside the patient's mouth.

5.  Finally, the osteo-odonto-keratoprosthesis is implanted in the center of the eye.

Results so far have been very encouraging for some these previously blind or severely visually impaired people.  How cool is that?

When I was in medical school many moons ago, a fellow UCSF student and close friend, Diane S. and I had the priviledge of accompanying a boy sent to Shriner's hospital in San Francisco back to Mexico to be reunited with his family.  He had severe corneal scarring because of a herpes viral infection.  He was not a candidate for corneal transplantation because he still had an active infection.  His parents were devastated when their son returned with the same problem he had before the "big trip" north.  They nevertheless graciously invited Diane and me to stay and celebrate the Christmas holidays with them.

I have often wondered whether the boy ever got his corneal transplant.  And, I wonder now if an an "osteo-odonto-keratoprosthesis" procedure would have been an additional option.

In the field of medicine, some of the most creative advances have come from the field of opthamology (e.g., online glaucoma screening and other advanced technologies that restore sight.  Blindless and decreased visual acuity are game-changers for people with these conditions.  Could it be possible that, in my lifetime, blindness is eradicated?