Investment in geo-engineering needed immediately, says Royal Society
Techniques such as CO2 removal and radiation reflection are "untested parachutes" until they are rigorously tested, it says
guardian.co.uk, Tuesday 1 September 2009 18.21 BST
Experiments on giant sunshades for the Earth and vast forests of artificial trees must begin immediately, according to the Royal Society, to ensure such mega-engineering plans are available as a safety net in case global talks to combat climate change fail.
The scientists spent a year assessing geo-engineering technologies, deliberate planet-scale interventions in the climate system that attempt to counteract global warming. Their report, the most comprehensive to date, concluded that immediate investment is required to discover whether the potential risks outweigh the benefits.
"Unless the world community can do better at cutting emissions, we fear we will need additional techniques such as geo-engineering to avoid very dangerous climate change in the future," said John Shepherd of the University of Southampton, who chaired the RS report.
"However, we are not advocates of geo-engineering - our opinions range from cautious consent to very serious scepticism about these ideas. It is not an alternative to emissions reductions and cannot provide an easy quick-fix to the problem."
Its report, published today, concluded that some approaches – such as capturing CO2 from the atmosphere using artificial trees or shooting tiny particles into the upper atmosphere to reflect away sunlight – looked promising. But all geo-engineering techniques had major uncertainties regarding their own environmental impacts.
The Royal Society considered two main categories of the technology. One involves reflecting a small amount, around 2%, of the solar radiation that reaches the Earth, thus preventing the planet from warming up. The other category involves removing greenhouse gases from the atmosphere.
"CO2 removal methods are preferable because removing greenhouse gases from the atmosphere addresses the problem at its root and is returning the earth"s climate system closer to its natural state," said Shepherd.
But he said crucial experimental data in the area was lacking. "We need to initiate research so we can understand the intended and unintended consequences of these methods so that, if we ever do need to deploy them, we can do so in a sensible and effective way."
The report calls for about £10m per year to be spent in the UK as part of a global £100m fund. "That"s about 10 times what is being spent now and about 10 times less than what we spend on climate change research," said Shepherd. "And it"s only 1% of what we spend on new energy technology."
Ken Caldeira, a climate scientist at the Carnegie Institution in California, said this early-stage research must be carried out as soon as possible. "The worst situation is to not test the options and then face a climate emergency and then be faced with deploying an untested option, a parachute that you"ve never tested out as the plane"s crashing."
Among the most promising technologies identified by the Royal Society are techniques to suck CO2 directly out of the atmosphere. The front-runner in this arena is a design by Klaus Lackner of Columbia University in New York. His artificial trees are not yet cost-effective to produce but Shepherd said it was probably just a matter of time.
Shooting sulphate aerosols into the stratosphere would also work well, said the Royal Society, as previous volcanic eruptions have showed in the past. When Mount Pinatubo in the Philippines erupted in 1991, for example, global temperatures dropped by 0.5C the following year. The costs would be relatively low but the scientists identified questions over potential adverse effects, in particular the destruction of the ozone layer.
Doug Parr, chief scientist at Greenpeace UK, said: "Geo-engineering is creeping onto the agenda because governments seem incapable of standing up to the vested interests of the fossil fuel lobby, who will use the idea to undermine the emissions reductions we can do safely.
"Intervening in our planet"s systems carries huge risks, with winners and losers, and if we can"t deliver political action on clean energy and efficiency then consensus on geo-engineering is a fantasy."
The Royal Society also pointed out that technical and scientific issues may not be the dominant ones when it came to the actual deployment of geo-engineering technology. Social, legal, ethical and political issues would be of equal significance and implementing global-scale projects would require a pre-existing international agreement.
"When it comes to techniques that need to be field-tested, and where that will occur in places beyond national jurisdiction, such as sulphate aerosols, then inevitably we"re looking at some kind of international governance framework," said Catherine Redgwell, a professor of international law at University College London and a member of the Royal Society working group on geoengineering.
At a meeting to launch the report at the Royal Society today, the government"s chief scientific adviser John Beddington said the government should be thinking about a modest investment in geoengineering research.
"It is appropriate that the UK continues to support international research in this area including the possibility of considering the types of global governance systems that would be needed for geo-engineering," he said.
Why coral reefs face a catastrophic future
Destroyed by rising carbon levels, acidity, pollution, algae, bleaching and El Ni?o, coral reefs require a dramatic change in our carbon policy to have any chance of survival
guardian.co.uk, Wednesday 2 September 2009 16.53 BST
Animal, vegetable and mineral, a pristine tropical coral reef is one of the natural wonders of the world. Bathed in clear, warm water and thick with a psychedelic display of fish, sharks, crustaceans and other sea life, the colourful coral ramparts that rise from the sand are known as the rainforests of the oceans.
And with good reason. Reefs and rainforests have more in common than their beauty and bewildering biodiversity. Both have stood for millions of years, and yet both are poised to disappear.
If you thought you had heard enough bad news on the environment and that the situation could not get any worse, then steel yourself. Coral reefs are doomed. The situation is virtually hopeless. Forget ice caps and rising sea levels: the tropical coral reef looks like it will enter the history books as the first major ecosystem wiped out by our love of cheap energy.
Today, a report from the Australian government agency that looks after the nation"s emblematic Great Barrier Reef reported that "the overall outlook for the reef is poor and catastrophic damage to the ecosystem may not be averted". The Great Barrier Reef is in trouble, and it is not the only one.
Within just a few decades, experts are warning, the tropical reefs strung around the middle of our planet like a jewelled corset will reduce to rubble. Giant piles of slime-covered rubbish will litter the sea bed and spell in large distressing letters for the rest of foreseeable time: Humans Were Here.
"The future is horrific," says Charlie Veron, an Australian marine biologist who is widely regarded as the world"s foremost expert on coral reefs. "There is no hope of reefs surviving to even mid-century in any form that we now recognise. If, and when, they go, they will take with them about one-third of the world"s marine biodiversity. Then there is a domino effect, as reefs fail so will other ecosystems. This is the path of a mass extinction event, when most life, especially tropical marine life, goes extinct."
Alex Rogers, a coral expert with the Zoological Society of London, talks of an "absolute guarantee of their annihilation". And David Obura, another coral heavyweight and head of CORDIO East Africa, a research group in Kenya, is equally pessimistic: "I don"t think reefs have much of a chance. And what"s happening to reefs is a parable of what is going to happen to everything else."
These are desperate words, stripped of the usual scientific caveats and expressions of uncertainty, and they are a measure of the enormity of what"s happening to our reefs.
The problem is a new take on a familiar evil. Of the billions of tonnes of carbon dioxide spewed from cars, power stations, aircraft and factories each year, about half hangs round in the thin layer of atmosphere where it traps heat at the Earth"s surface and so drives global warming. What happens to the rest of this steady flood of carbon pollution? Some is absorbed by the world"s soils and forests, offering vital respite to our overcooked climate. The remainder dissolves into the world"s oceans. And there, it stores up a whole heap of trouble for coral reefs.
Often mistaken for plants, individual corals are animals closely related to sea anemones and jellyfish. They have tiny tentacles and can sting and eat fish and small animals. Corals are found throughout the world"s oceans, and holidaymakers taking a swim off the Cornish coast may brush their hands through clouds of the tiny creatures without ever realising.
It is when corals form communities on the sea bed that things get interesting. Especially in the tropics. Yes, Britain has its own rugged coral reefs, but such deep-water constructions are too remote, cold and dark to really fire the imagination. It is in shallow, brightly light waters, that coral reefs really come to life. In the turquoise waters of the Caribbean, Indian Ocean and Pacific, the coral come together with tiny algae to make magic.
The algae do something that the coral cannot. They photosynthesise, and so use the sun"s energy to churn out food for the coral. In return, the coral provide the algae with the carbon dioxide they need for photosynthesis, and so complete the circle of symbiotic life.
Freed of the need to wave their tentacles around to hunt for food, the coral can devote more energy to secreting the mineral calcium carbonate, from which they form a stony exoskeleton. A second type of algae, which also produces calcium carbonate, provides cement. Together, the marine menage-a-trois make a very effective building site, with dead corals leaving their calcium skeletons behind as limestone. For all their apparent beauty and fragility, just think of coral reefs as big lumps of rock with a living crust.
A fragile crust too. The natural world is a harsh environment for coral reefs. They are under perpetual attack by legions of fish that graze their fields of algae. Animals bore into their shells to make homes, and storms and crashing waves break them apart. They may appear peaceful paradises, but most coral reefs are manic sites of constant destruction and frantic rebuilding. Crucially though, for millions of years, these processes have been in balance.
Human impact has tipped that balance. Loaded with the agricultural nutrients nitrates and phosphates, rivers now spill their polluted waters into the sea. Sediment and sewage cloud the clear waters, while over-fishing plays havoc with the finely tuned community of fish and sharks that kept the reef nibbling down to sustainable levels. All of this is enough to wreck coral without any help from climate change.
Global warming, predictably, has made the situation worse. Secure in their tropical currents, coral reefs have evolved to operate within a fairly narrow temperature range, yet, in the late 1970s and 1980s, coral scientists got an unpleasant demonstration of what happens when the hot tap is left on too long. "The algae go berserk," said Rogers. Scientists think the algae react to the warmer water and increased sunlight by producing toxic oxygen compounds called superoxides, which can damage the coral. The coral respond by ejecting their algal lodgers, leaving the reefs starved of nutrients and deathly white. Such bleaching was first observed on a large scale in the 1980s, and reached massive levels worldwide during the 1997-98 El Ni?o weather event.
On top of a human-warmed climate, the 1997-98 El Ni?o, caused by pulses of warming and cooling in the Pacific, drove water temperatures across the world beyond the coral comfort zone. The mass bleaching event that followed killed a fifth of coral communities worldwide, and though many have recovered slightly since, the global death toll attributed to the 1997-98 mass bleaching stands at 16%. "At the moment the reefs seem to be recovering well but it"s only a matter of time before we have another [mass bleaching event]," says Obura.
With its striking images of skeletal reefs stripped of colour and life, coral bleaching offers photogenic evidence of our crumbling biodiversity, and has placed the plight of coral reefs higher on the world"s consciousness. Head along to your local swimming pool for diving lessons these days, and chances are that you will be offered a coral conservation course as well.
Katy Bloor, an instructor at Sub-Mission Dive School in Stoke-on-Trent, says many divers are not aware of the problems corals face, particularly as holiday operators tend to visit reefs in better condition. "Most have probably dived on a coral reef that they thought was a bit rubbish, but they haven"t considered why," she said.
If anyone knows what they are missing out on, it should be Charlie Veron. So what does it feel like to dive on a pristine reef? "I have not seen many reefs that can be called pristine, and none exist now," he says. "But if I had to take a punt, I was diving on the Chesterfield Reefs, east of New Caledonia [in the southwest Pacific] about 30 years ago and was staggered by the wealth of life, especially big fish which were so thick that I was hardly ever able to photograph coral. That place made even remote parts of the Great Barrier Reef look second rate.
"I can only describe it like walking through a rainforest dripping with orchids, crowded with birds and mammals of bewildering variety and trees growing in extreme profusion."
Can the coral be helped? If planting more trees can regrow a forest, can coral be introduced to bolster failing reefs? There are a handful of groups working on the problem, many of which have reported encouraging results. Off Japan, scientists are farming healthy coral on hundreds of ceramic discs, which they plan to transplant onto the badly-bleached Sekisei Lagoon reef within two years. In 30 years or so, they hope the reef can recover fully.
A similar, if more low-tech, exercise is under way in the Philippine coastal community of Bolinao, where local people have broken off chunks from the healthy section of their local reef and have crudely wedged them into cracks in bleached sections. Others have cultured corals in swimming pools, and researchers in the Maldives are using giant sunken cages, connected to a low level electric current, to help coral form their chalky shells.
But the problem with all these efforts, according to Rogers at the ZSL, is that they cannot address the looming holocaust that reefs face. A new, terrible curse that comes on top of the bleaching, the battering, the poisoning and the pollution.
Remember the carbon dioxide that we left dissolving in the oceans? Billions and billions of tonnes of it over the last 150 years or so since the industrial revolution? While mankind has squabbled, delayed, distracted and dithered over the impact that carbon emissions have on the atmosphere, that dissolved pollution has been steadily turning the oceans more acidic. There is no dispute, no denial, about this one. Chemistry is chemistry, and carbon dioxide plus water has made carbonic acid since the dawn of time.
As a result, the surface waters of the world"s oceans have dropped by about 0.1 pH unit – a sentence that proves the hopeless inadequacy of scientific terminology to express certain concepts. It sounds small, but is a truly jaw-dropping change for coral reefs.
For reefs to rebuild their stony skeletons, they rely on the seawater washing over them to be rich in the calcium mineral aragonite. Put simply, the more acid the seawater, the less aragonite it can hold, and the less corals can rebuild their structure. Earlier this year, a paper in the journal Science reported that calcification rates across the Great Barrier Reefs have dropped 14% since 1990. The researchers said more acidic seas were the most likely culprit, and ended their sober write-up of the study with the extraordinary warning that it showed "precipitous changes in the biodiversity and productivity of the world"s oceans may be imminent".
Rogers says carbon dioxide levels in the atmosphere are already over the safe limits for coral reefs. And even the most ambitious political targets for carbon cuts, based on limiting temperature rise to 2C, are insufficient. Their only hope, he says, is a long-term carbon concentration much lower than today"s. The clock must somehow be wound back and carbon somehow sucked out of the air. If not, then so much more carbon will dissolve in the seas that the reefs will surely crumble to dust. Given the reluctance to reduce emissions so far, the coral community is not holding its breath.
"I just don"t see the world having the commitment to sort this one out," says Obura. "We need to use the coral reef lesson to wake us up and not let this happen to a hundred other ecosystems."
Reefs to see before they die<\/h2>
Florida Keys, United States
The only coral reef system in the continental US and the third largest in the world, stretching 221 miles down the Florida coast. The US National Marine Fisheries Service says live coral is down 50-80% in the last decade, mainly due to damage by humans.
Threatened by sewage disposal, inland agricultural run-off and eutrophication, as well as tourist activities such as glass-bottom boat trips. Hurricanes hinder reef recovery and Caribbean coral cover has declined 80% in 25 years.
Scarborough Reef, South China Sea
Ownership disputes between the Philippines, mainland China and Taiwan mean the waters surrounding this reef are heavily overfished, and mangled by the blasts and cyanide used to maximise catch.
Reefs of the windward Southeast Hawaiian Islands, US
Management is improving around the main Hawaiian islands such as Oahu and Maui, but over-fishing and organic sediment from plantations remain major threats.
Seribu Islands, Java Sea, Indonesia
Spanning over 108,000 hectares and 100 small islands, this reef is a significant contributor to the Indonesian tourism economy. Rapid urban development poses threats from domestic and industrial waste, urban run-off and oil and gas exploration. The 1997-1998 El Ni?o event triggered severe bleaching and killed over 90% of the coral down to 25 metres.
Stable but for how long?<\/h2>
The Great Barrier Reef
The globe"s largest coral reef ecosystem, composed of over 2,900 individual reefs and stretching over 3,000km, is the best example of reef management with little damage since 2004. Significant bleaching occurred in 1998, 2002 and 2006.
The Red Sea Riviera, Gulf of Aqaba, Egypt, Israel and Jordan
These reefs continue to remain in good health despite intense tourism. Coral cover remains high to very high, despite localised losses from coral bleaching and crowns-of-thorns starfish, which prey on coral polyps.
Mombasa National Marine Park, Kenya
Adjacent to the most heavily populated beach along the Kenyan coast, damage due to tourism is inevitable. In 1989 the area was pronounced a marine park, leading to an increase in recorded coral cover from 8 to 30%.
Reefs of the Seychelles, Indian Ocean
Lost some 90% of coral cover during the 1998 El Nino event. Slowly recovering due to granitic coral, which is more resistant and supports regrowth.
Surin Islands, Thailand
The reefs located off this group of islands were weakened by the 2004 Indian Ocean tsunami The majority of the damage is localized and low impact, but the coral is now more susceptible to future destruction.
Alcohol and coffee linked to heartbeat problems
David Rose, Health Correspondent, in Barcelona
August 30, 2009
Drinking more than ten alcoholic drinks a week or four cups of strong coffee each day can increase the risk of developing an irregular heartbeat, new research suggests.
Two studies presented at the European Society of Cardiology congress in Barcelona found that alcohol and caffeine intake can affect the chances of developing an abnormal heart rhythm, known as atrial fibrillation.
About 46,000 people in Britain are diagnosed with atrial fibrillation every year. The condition greatly increases the risk of having a stroke, heart attack or other cardiac problems.
The study into alcohol, carried out on 8,830 men and women in Britain, Scandinavia and the United States, found that those who drank the equivalent of ten standard drinks — about 15 units a week — had an 80 per cent increased risk of being diagnosed with the condition within five years.>
The Department of Health advises that men should drink no more than 21 units of alcohol a week, and women no more than 14. A 125ml glass of red or white wine or half a pint of 5 per cent lager contain about 1.5 units. A standard large glass of wine in a bar is 250ml.
The patients in the study had an average age of 67 and were already receiving treatment for high blood pressure but had no previous signs of atrial fibrillation. They were followed up for an average of 4.8 years, during which time heart scans revealed atrial fibrillation in 5.7 per cent of patients who reported drinking more than ten units a week, compared to 3.9 per cent of patients who drank less or no alcohol at all.
Inger Ariansen, who led the study at Oslo University Hospital, suggested that ten standard drinks could be regarded as a threshold for increased risk of atrial fibrillation, although she pointed out that different countries defined the amount of alcohol contained in a typical drink differently.
The second study, by researchers at the University of Modena, found that drinking more than the equivalent of four espresso shots a day could increase the risk of arrhythmias in people without known heart disease, even if they otherwise had a healthy diet.
Peter Weissberg, medical director of the British Heart Foundation, said that the recommended limits for drinking alcohol a week were formulated to avoid the risk of liver disease and other drink-related health problems. “But there is no doubt that some patients are more susceptible to the effects of alcohol on the heart and it may be that a subset of people who metabolise alcohol differently are at increased risk of atrial fibrillation.”
He added that he was not aware of any direct evidence that drinking caffeine increased the risk of atrial fibrillation, “but it wouldn’t be surprising if you found that”.
Drugs given during labour linked to breastfeeding problems
From The Times on line >
September 1, 2009
David Rose, Health Correspondent
Drugs and painkillers that are routinely given to women in labour may reduce their ability to breastfeed their baby, reseachers say.
A study seen by The Times ahead of its publication today, suggests that life-saving medication given to nearly all women to prevent and treat bleeding after birth is linked to reduced breastfeeding rates.
The findings indicate a potential biological reason for why so many women in Britain fail to breastfeed, despite government efforts to increase the number of infants receiving their mother’s milk.
The Department of Health recommends that all children are breastfed for the first six months, because of the health benefits it can provide for both mother and baby. But breastfeeding rates in Britain are among the lowest in Europe, with only 45 per cent of infants exclusively breastfed a week after birth, and one in four receiving only formula milk from birth.>
Analysis of the records of more than 48,000 women who gave birth in South Wales found that use of the clotting agents oxytocin or ergometrine was associated with a 7 per cent decline in the proportion who started breastfeeding within 48 hours of giving birth.
It is thought that the drugs may impede a woman’s ability to produce milk, suggesting that mothers who have them may need greater time or support from midwives if they wish to breastfeed their baby.
The study, by researchers at Swansea University, also confirmed the link between high doses of injected pain relief and lower rates of breastfeeding, an association that has recently prompted revised guidelines for the NHS on the use of epidurals in labour.
Sue Jordan, who led the study, said that the Government’s target to increase breastfeeding rates by 2 per cent a year was “unlikely to be met” unless further research was carried out. Young mothers or those discouraged from breastfeeding for social or cultural reasons are more likely to feed their babies from a bottle, but the main reasons cited for failure to breastfeed are a lack of milk or babies that simply refuse to feed.
Of the women involved in the study, who all gave birth between 1989 and 1999, two thirds (65.5 per cent) of those who did not receive drugs to prevent post-partum haemorrhage started breastfeeding their baby within 48 hours of giving birth.
But the proportion of those doing so reduced to 59.1 per cent among those given an injection of oxytocin, a hormone that plays an important natural role in labour, and to 56.4 per cent of women given an additional injection of ergometrine, given to address actual bleeding.
Overall, nearly eight out of ten (79 per cent) of the women in the study received either oxytocin, ergometrine or both. It is routine for women being treated on the NHS to be offered these drugs. The decline of 6-7 per cent in those being breastfed could lead to up to 50,000 fewer British babies being breastfed every year than might otherwise be possible, she added.
Because of the health benefits of breastfeeding, 50,000 bottle-fed infants represents the possibility of about 1,000 children becoming clinically obese, or 3,000 additional cases of childhood asthma. It could also greatly increase the number of mothers affected by breast cancer.
The findings are published today in BJOG: An International Journal of Obstetrics and Gynaecology.
Dr Jordan said: “The potentially life-saving treatments to prevent bleeding after birth must not be compromised on the basis of this study but further studies are required to establish ways to minimise any effects on breastfeeding rates."
Rosemary Dodds, policy research officer for the National Childbirth Trust, said: “Women need more support to start breastfeeding soon after giving birth and this study adds weight to that.
“A lot of women are not given enough information about the medications that might be given to them during childbirth, and women at low risk of bleeding may not need to take these drugs.
“It is important that women understand the risks and can give their informed consent before they go into labour.”>
Cosmetic surgery boom in youth
TEHRAN -- Nose surgery or rhinoplasty, has became epidemic among Iranians aged 18 and under, a secretary of the second International Rhinology Congress said here on Saturday.
Ebrahim Razmpa blamed the increase on keeping up with the Joneses and the importance of nose in creating normal contours of face.
Swine flu, a looming storm
TEHRAN -- If the current trend continues, high swine flu death rate is inevitable in Iran, an official at the Health Ministry warned here on Sunday.
About 7 to 8 percent of those being treated in hospitals across the country for swine flu could die, Mahmoud Nabavi said.
Mouth cancer: The self-examination everybody should be doing
Mon,31 August 2009
While mouth cancer is the sixth most common malignancy reported worldwide, few people know about its risks and warning signs.
Regular self-examination is now the norm for breast cancer and testicular cancer, but how often do you examine your mouth for signs of oral cancer? And if you did, would you know what to look for
Although there no apparent lifestyle triggers in 25% of cases, over 70% are associated with smoking, drinking alcohol, over exposure to the sun and chewing tobacco, areca or betel nut. While the death rate has halved for men over 70, it has steadily increased for younger men and women in their 30s, 40s and 50s. And experts warn that some strains of the
human papillomavirus (HPV), which is usually implicated with cervical cancer, has contributed to the rise in younger people
“If you don"t know the sexual history of your partner then it is always advisable to wear protection,” said Carter. “In the last ten years there has been more than a 30% rise in cases in people under 45. This is largely due to young people becoming more sexually active. If you have had more than five oral-sex partners in your lifetime, you are two-and-a-half times more likely to develop oral cancer.”
Mouth cancer frequently goes unnoticed as Irish author Lia Mills, who was diagnosed in 2006, recalls.
By the time Lia had gone to see her GP the patch in her mouth was painful and she had developed a lump in her neck. She was diagnosed with squamous cell carcinoma and needed radical surgery, which included removal of her lower jaw, part of her cheek and removal of the lymph nodes in her neck, followed by extensive radiotherapy.
“Regular dental examinations and early screening are vital for early diagnosis and survival,” said Carter. “Also a diet with plenty of vegetables rich in vitamin A, C and E offers protection against the development of many types of cancer including mouth cancer.”
• Pull out your cheek so that you can see inside. Look for red, white or dark patches.
• Then put your finger on the inside of your cheek and your thumb on the outside and check for any lumps or tenderness. Do the same on the other side.
• Tilt back your head and open your mouth so that you can see the roof of your mouth. Check for any lumps or colour changes.
• Stick your tongue out and look at the surface. Gently pull your tongue out and
• Gently press along the floor of the mouth for any swelling or lumps.
-Chew tobacco products
-Exposure to sunlight
-Habits of lip or cheek biting
-Any ulcers or sore that do not heal within three weeks
-Swelling, lumps or bumps on the lips, gums or other areas inside the mouth
-White, red or dark patches in the mouth
-Repeated bleeding in the mouth
-Any numbness, loss of feeling or pain of the face, mouth or neck
As science progresses, health care management is faltering
Mon,31 August 2009
We have the technology, and often the money and the will, but poor management of our medical systems is preventing us from delivering quality health care, says a new report
Over the past few decades, there have been astonishing innovations in the field of biotechnology. But these new capabilities have not necessarily translated into better health care worldwide, according to a new report.
This advice goes as much for people living in wealthy developed nations as it does for those in the developing world. In fact, according to Khemka, health care systems that receive a lot of money (most developed nations spend at least 10 percent of their gross domestic product on health care and the US infamously spends closer to 20 percent) are vulnerable to another danger: over intervention by doctors.
Zen and the Art of Coping With Alzheimer"s
By DENISE GRADY
< src="http://graphics8.nytimes.com/js/print_todays_date.js" type=text/java>> Monday, August 31, 2009
The number of Alzheimer"s patients is expected to increase dramatically in coming years, straining the health care system.
Scientists have not discovered the cause nor devised effective treatments. Even diagnosis is difficult.
In the absence of therapies, attention has turned to teaching the skills necessary to cope with demented patients.
Increasingly caregivers are encouraged to validate the feelings and perceptions of the person with Alzheimer"s.
During the YouTube forum with the Democratic presidential candidates in July, the first question about health care came from two middle-age brothers in Iowa, who faced the camera with their elderly mother. Not everybody with Alzheimer’s disease has two loving sons to take care of them, they said, adding that a boom in dementia is expected in the next few decades.
“What are you prepared to do to fight this disease now?” they asked.
The politicians mouthed generalities about health care, larded with poignant anecdotes. None of them answered the question about Alzheimer’s.
Science hasn’t done much better. There is no cure for Alzheimer’s and no way to prevent it. Scientists haven’t even stopped arguing about whether the gunk that builds up in the Alzheimer’s brain is a cause or an effect of the disease. Alzheimer’s is roaring down — a train wreck to come — on societies all over the world.
People in this country spend more than a $1 billion a year on preion drugs marketed to treat it, but for most patients the pills have only marginal effects, if any, on symptoms and do nothing to stop the underlying disease process that eats away at the brain. Pressed for answers, most researchers say no breakthrough is around the corner, and it could easily be a decade or more before anything comes along that makes a real difference for patients.
Meanwhile, the numbers are staggering: 4.5 million people in the United States have Alzheimer’s, 1 in 10 over 65 and nearly half of those over 85. Taking care of them costs $100 billion a year, and the number of patients is expected to reach 11 million to 16 million by 2050. Experts say the disease will swamp the health system.
It’s already swamping millions of families, who suffer the anguish of seeing a loved one’s mind and personality disintegrate, and who struggle with caregiving and try to postpone the wrenching decision about whether they can keep the patient at home as helplessness increases, incontinence sets in and things are only going to get worse.
Drug companies are placing big bets on Alzheimer’s. Wyeth, for instance, has 23 separate projects aimed at developing new treatments. Hundreds of theories are under study at other companies large and small. Why not? People with Alzheimer’s and their families are so desperate that they will buy any drug that offers even a shred of hope, and many will keep using the drug even if the symptoms don’t get better, because they can easily be convinced that the patient would be even worse off without it.
It is telling, maybe a tacit admission of defeat, that a caregiving industry has sprung up around Alzheimer’s. Books, conferences and Web sites abound — how to deal with the anger, the wandering, the sleeping all day and staying up all night, the person who asks the same question 15 times in 15 minutes, wants to wear the same blouse every day and no longer recognizes her own children or knows what a toilet is for.
The advice is painfully and ironically reminiscent of the 1960s and ’70s, the literal and figurative high point for many of the people who are now coping with demented parents. The theme is, essentially, go with the flow. People with Alzheimer’s aren’t being stubborn or nasty on purpose; they can’t help it. Arguing and correcting will not only not help, but they will ratchet up the hostility level and make things worse. The person with dementia has been transported into a strange, confusing new world and the best other people can do is to try to imagine the view from there and get with the program.
If a patient asks for her mother, for instance, instead of pointing out that her mother has been dead for 40 years, it is better to say something like, “I wish your mother were here, too,” and then maybe redirect the conversation to something else, like what’s for lunch.
If Dad wants to polish off the duck sauce in a Chinese restaurant like it’s a bowl of soup, why not? If Grandma wants to help out by washing the dishes but makes a mess of it, leave her to it and just rewash them later when she’s not looking. Pull out old family pictures to give the patient something to talk about. Learn the art of fragmented, irrational conversation and follow the patient’s lead instead of trying to control the dialogue.
Basically, just tango on. And hope somebody will do the same for you when your time comes. Unless the big breakthrough happens first.
Think of Your Poor Feet
By LAURIE TARKAN
Monday, August 31, 2009
Huge numbers of people develop foot pain in their 60s, but it can start as early as the 20s and 30s.
Excessive weight, diabetes and circulation problems can contribute to foot pain.
Proper footwear and regular exercise can play a crucial role in preventing foot problems.
The average person walks the equivalent of three times around the Earth in a lifetime. That is enormous wear and tear on the 26 bones, 33 joints and more than 100 tendons, ligaments and muscles that make up the foot.
In a recent survey for the American Podiatric Medical Association, 53 percent of respondents reported foot pain so severe that it hampered their daily function. On average, people develop pain in their 60s, but it can start as early as the 20s and 30s. Yet, except for women who get regular pedicures, most people don’t take much care of their feet.
“A lot of people think foot pain is part of the aging process and accept it, and function and walk with pain,” said Dr. Andrew Shapiro, a podiatrist in Valley Stream, N.Y. Though some foot problems are inevitable, their progress can be slowed.
The most common foot conditions that occur with age are arthritic joints, thinning of the fat pads cushioning the soles, plantar fasciitis (inflammation of the fibrous tissue along the sole), bunions (enlargement of the joint at the base of the big toe), poor circulation and fungal nails. The following questions will help you assess whether you should take more preventive action as you age.
Are you overweight? The force on your feet is about 120 percent of your weight. “Obesity puts a great amount of stress on all the supporting structures of the foot,” said Dr. Bart Gastwirth, a podiatrist at the University of Chicago. It can lead to plantar fasciitis and heel pain and can worsen hammertoes and bunions. It’s also a risk factor for diabetes, leading to the next question.
Are you diabetic? Being farthest from the heart, the feet can be the first part of the body to manifest complications like poor circulation and loss of feeling, both of which can lead to poor wound healing and amputation. Diabetics should have their feet examined annually by a doctor and avoid shoes that cause abrasions and pressure.
Do you have poor circulation? If you suffer from peripheral artery disease — a narrowing of veins in the legs — your feet are more susceptible to problems, said Dr. Ross E. Taubman, president of the American Podiatric Medical Association. Smoking also contributes to poor circulation.
Do your parents complain about their feet? Family history is probably your biggest clue to potential problems.
Do you have flat feet or high arches? Either puts feet at risk. A flat foot is squishy, causing muscles and tendons to stretch and weaken, leading to tendinitis and arthritis. A high arch is rigid and has little shock absorption, putting more pressure on the ball and heel of the foot, as well as on the knees, hips and back. Shoes or orthotics that support the arch and heel can help flat feet. People with high arches should look for roomy shoes and softer padding to absorb the shock. Isometric exercises also strengthen muscles supporting the foot.
Are you double-jointed? If you can bend back your thumb to touch your lower arm, the ligaments in your feet are probably stretchy, too, Dr. Gastwirth said. That makes the muscles supporting the foot work harder and can lead to injuries. Wear supportive shoes.
Do your shoes fit? In the podiatric association’s survey, more than 34 percent of men said they could not remember the last time their feet were measured. Twenty percent of women said that once a week they wore shoes that hurt, and 8 percent wore painful shoes daily. Feet flatten and lengthen with age, so if you are clinging to the shoe size you wore at age 21, get your feet measured (especially mothers — pregnancy expands feet).
Do you wear high heels? “The high heel concentrates the force on the heel and the forefoot,” Dr. Gastwirth said. Heels contribute to hammertoes, neuromas (pinched nerves near the ball of the foot), bunions and “pump bump” (a painful bump on the back of the heel), as well as toenail problems. Most of the time, wear heels that are less than two and a half inches high.
Do your feet ever see the light of day? Fungus thrives in a warm, moist environment. Choose moisture-wicking socks (not cotton), use antifungal powders and air out your toes at home.
Have you seen a podiatrist? Minor adjustments, using drugstore foot pads or preion orthotics, can relieve the pressure on sensitive areas, rebalance the foot and slow the progress of a condition.
Do you walk? Putting more mileage on your feet is the best way to exercise the muscles and keep them healthy.
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