May 20, 2011
NIH Podcast Episode #0134
Balintfy: Welcome to episode 134 of NIH Research Radio with news about the ongoing medical research at the National Institutes of Health – the nation's medical research agency. I'm your host Joe Balintfy. Coming up in this episode a boom in older drivers and what that may mean, May is Healthy Vision Month, and Lupus Awareness Month, plus, an addiction performance…
“It’s a very special kind of medicine. I have to take it because there is no other that can stop the pain – all the pain…”
Helping healthcare providers start a conversation about a patient’s drug use. But first, this news update. Here’s Craig Fritz.
Fritz: Researchers supported by NIH have found that a drug currently used to treat adults with sickle cell disease is also effective for young children. Scientists found that the drug reduced pain episodes and improved a key blood measurement for children aged 8-19 months. Sickle cell disease is an inherited blood disorder that affects approximately 100,000 Americans. It is most prevalent in people of African, Hispanic, Mediterranean, and Middle Eastern descent. The study was designed to determine whether the drug could protect spleen and kidney function in very young children with sickle cell disease. Loss of spleen function is associated with increased risks of serious bacterial infections. The study also sought to determine whether the treatment would reduce the frequency of other complications, including pain events and hospital stays. Researchers note that there are now strong reasons for health care professionals to consider starting this treatment for children who have sickle cell disease as early as possible.
Scientists at NIH have developed a more accurate method for estimating breast cancer risk for Asian and Pacific Islander American women. Most current risk estimates rely on data from non-Hispanic white women, but researchers have now updated a risk assessment tool to more specifically assess risk for American women who identify as Chinese, Japanese, Filipino, Hawaiian, other Pacific Islander, or other Asian. This risk calculator is used to counsel women and to determine eligibility for breast cancer prevention trials. Like other risk projection models, researchers recommend this only be used in consultation with a physician. For more information on the updated breast cancer risk assessment tool, visit www.cancer.gov.
For this NIH news update – I’m Craig Fritz
Balintfy: News updates are compiled from information at www.nih.gov/news. Coming up, timely features on healthy eyes and lupus; later a special feature on the Addiction Performance Project – you’ll learn what that is – and getting older doesn’t make someone a bad driver; but there are changes that may affect the driving skills of baby boomers; that’s next on NIH Research Radio.
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Baby boom and older drivers
Balintfy: In this and coming episodes of NIH Research Radio, we’ll be talking a lot about issues surrounding the baby-boom generation. The first of America's baby boomers—people born between 1946 and 1964—are reaching their 65th birthdays in 2011. That has a lot of implications for the future of the nation’s health, and may have implications for the nation’s roads.
King: We'll see another two million or so drivers over the age of 65 coming in as it were too being an older driver.
Balintfy: But Dr. Jonathan King at the National Institutes of Health says those older drivers may not make a big impact.
King: What they do is they drive less.
Balintfy: Dr. King explains that the data on older drivers show that the total number of accidents and fatalities in older drivers is actually much smaller than in teenagers and people in their older 20s.
King: What we do see is because older drivers drive a lot less, the per-mile data or the per-trip data, you start to see an increase in accidents and unfortunately in fatalities as well that becomes most obvious for drivers who are over the age of 80 or so. At that point, you then start to see death rates that actually approach those of people who are teenagers.
Balintfy: Getting older doesn’t make someone a bad driver. But there are changes that may affect driving skills over time. Dr. King explains that older drivers, like all older adults, are more likely to have various physical issues that are preventing them from driving as well as they used to.
King: There's arthritis. There's inability to make the head turn to look in the side window. There are changes in vision, but most older drivers are fairly cognizant of those and will drive less if at night or if they know that they have visual issues.
Balintfy: But Dr. King adds that there are changes that affect drivers that they might not realize, changes in their cognition.
King: These are basically changes that are responsible for them to be able to pay attention not just to the task that they're doing, the driving task, but to the situations that occur while you're driving that you suddenly have to pay attention to and react to. Whether it's somebody coming, creeping into your lane from the street you're approaching or if it's the fact that the driver in front of you just applied their brakes while you're actually looking at the road signs to make sure you're going in the right direction.
Balintfy: Dr. King notes there is some evidence that training programs may help older drivers to drive for longer, for example a Useful Field of Vision Test.
King: And there's some indication that it will allow them, it may enable them to have fewer motor vehicle collisions, at least at-fault ones, than drivers who haven't had the testing.
Balintfy: Overall, Dr. King suggests that despite the fact that there is a growing concern given the increasing number of older drivers:
King: I think we're fairly lucky. The cars themselves have been getting much safer. The accident rates have not been skyrocketing. We do have some interventions under testing that maybe fruitful.
Balintfy: Dr. King recommends a specific “Age Page” with more information for Older Drivers. Find it online at www.nia.nih.gov.
Healthy Vision Month in May
Balintfy: In that last feature Dr. King mentioned that older drivers usually notice vision changes and cut back on their driving. But changes in eye health don’t always have symptoms until it’s too late. During Healthy Vision Month, health experts are encouraging people and organizations around the world to recognize the value of the sense of sight and make vision health a priority.
Bishop: Healthy Vision Month is a national observance that raises awareness of eye health.
Balintfy: And the importance of a comprehensive dilated eye exam, says Dr. Rachel Bishop, an ophthalmologist at the National Institutes of Health.
Bishop: The comprehensive dilated eye exam allows the doctor to see all the structures of the eye.
Balintfy: The best way to detect vision problems at the earliest, most treatable stages, is through a comprehensive dilated eye exam. This simple, painless procedure allows an eye care professional to examine the eye and gain a more complete look at any changes in eye health.
Bishop: Some people might view an eye exam as inconvenient. The dilating drops can cause blurred vision for a few hours, sensitivity to light for a few hours. From our end, from our perspective, it's a price worth paying because there really is no other way of examining the sensitive eye structures to determine whether the nerve and retina are healthy. So if someone has an eye exam and they haven’t had their vision blurred or they don’t notice that they are a little more sensitive to light, they may not have a dilated eye exam. They might have just gone and checked for glasses.
Balintfy: Dr. Bishop says it is not just to check whether someone needs glasses or not.
Bishop: For the most common eye diseases, there are no early warning signs. So without a dilated eye exam, the doctor would not be able to tell if a person had the early changes from glaucoma, or diabetes, or macular degeneration for example.
Balintfy: An estimated 14 million Americans are currently visually impaired, and this number continues to grow as the population ages.
Bishop: The largest group at high risk of eye disease are the elderly. Actually, people above the age of 40 begin to show changes from the most common eye diseases and in greater numbers above the age of 65. Among the African-America and Hispanic communities, the rates of glaucoma are higher and women are at higher risk for some more common eye problems like dry eye disease.
Balintfy: Of adults aged 40 and older, more than 4 million currently have diabetic retinopathy, more than 2 million have glaucoma, and more than 1.75 million have age-related macular degeneration.
Bishop: As people age, it's increasingly important for them to have regular eye exams to detect age-related eye diseases because, as we've said, there are no early warning signs for the most common causes of blindness in the United States. And so the only way to detect them is through a complete dilated eye exam.
Balintfy: Dr. Bishop says whole body health can help with eye health, and it shows in a comprehensive dilated eye exam.
Bishop: The body is made up of common tissues throughout. And I think there’s every reason to believe that what would keep the heart and the blood vessels healthy would also keep the structures of the eye healthy. And there’s some evidence to suggest that already. Evidence shows, for example, that people who consume diets high in omega-3 fatty acids and certain of the antioxidants which we've studied in our age-related eye disease study at the National Eye Institute that these people have lower rates of progression of macular degeneration. There are certain diets that promote lower rates of or improved dry eye symptoms. Omega-3 fatty acids are also linked with improvement of dry eye.
Balintfy: To get more information about Healthy Vision Month and resources for raising eye health awareness, including e-cards, educational handouts, and teaching tools, visit www.nei.nih.gov/hvm.
What is lupus?
Balintfy: May is Healthy Vision Month; it is also Lupus Awareness Month. Lupus is an autoimmune disease. Normally the body's immune system protects against viruses, bacteria and other foreign invaders. In an autoimmune disorder like lupus, the immune system cannot tell the difference between foreign substances and its own cells and tissues. Lupus in fact can affect many parts of the body, including the skin, joints, heart, lungs, blood, kidneys, and brain. Frances Ashe-Goins, a deputy director, at the U.S. Department of Health and Human Services says many symptoms of lupus may be related to internal organs.
Ashe-Goins: One of the biggest things that people don’t pay much attention to is aches and pains, okay. So they'll think it’s just arthritis. But if you're 22 and you've got the aches and pains and you haven’t been running around or doing something extra strenuous, then perhaps there might be a symptom. But it wouldn’t be that by itself. There is another one and a person feels just so very, very tired and they can't -- some days they can get up out of bed, other days they can't. And it's not laziness. It's not they've had too much activity. This tiredness comes from absolutely nowhere that they can put their fingers on.
Balintfy: She says other symptoms can be hair loss or memory loss. Ashe-Goins adds that if you recognize the symptoms of lupus in yourself or a family member, you should see a healthcare provider.
Ashe-Goins: We're not saying self-diagnose. What we're saying is if you see some of the symptoms, go to your healthcare provider and get further medical evaluation if needed.
Balintfy: It is estimated that more than 16-thousand Americans develop lupus each year; and it is more common among African Americans, Asians, Hispanics, and Native Americans than Caucasians. More than 90 percent of people with lupus are women between the ages of 15 and 45. Ashe-Goins also notes that a family history of lupus is a major risk factor, which is why she recommends completing a family medical history.
Ashe-Goins: If you've never done a family medical history before, you really need to do one. And if anybody in your family has had an autoimmune disease, lupus or anything else, then you need to take a closer look at what's happening in your family. And early diagnosis is much, much better.
Balintfy: For many people, lupus can be a manageable disease with relatively mild symptoms. For others, it may cause serious and even life-threatening problems. For more information on lupus, visit www.couldihavelupus.gov. And to hear an interview with Frances Ashe-Goins about lupus awareness, listen to the Pinnpoint on Women’s Health podcast at www.orwh.nih.gov. When NIH Research Radio continues, a dramatic look at addiction education. That’s next.
(BREAK FOR PUBLIC SERVICE ANNOUNCEMENT)
Addiction Performance Project
Balintfy: Welcome back to NIH Research Radio. Way before film and television, and radio or podcasts, theater was the main medium for telling stories. It still is a powerful and effective way to share and experience ideas and emotions. And now, a way to help healthcare providers break down the stigma associated with addiction.
Doerries: Welcome to the Addiction Performance Project. My name is Brian Doerries; I’m the artistic director of Outside the Wire and director of today’s performance…
Balintfy: The Addiction Performance Project programs have appeared in Boston, Washington, DC and Phoenix, Arizona with the goal of promoting a healthy dialogue that fosters compassion, cooperation, and understanding for patients living with this disease.
Doerries: The rationale behind the Addiction Performance Project is that it's a way to gather diverse medical communities and bring them together to be in the presence of actors who are performing a narrative written half a century ago in which a patient is struggling with addiction.
Balintfy: The narrative is Eugene O’Neil’s Pulitzer Prize-winning, Long Day’s Journey into Night. Doerries sets the stage, explaining that the play takes place in the Tyrone summer home, over the span of one day.
Doerries: Over the span of this one day, Mary Tyrone after years of on-and-off treatment for her morphine addiction has begun using morphine again, something her sons Edmond and Jamie, and her husband James now suspect, but are reluctant or perhaps even unwilling to acknowledge. So what do they do: instead of staying with Mary in the home in the house, they go out drinking to dull the pain of what awaits them at home. And they have multiple reasons to drink. Edmond, the youngest son loosely based on O’Neil himself, was just diagnosed with tuberculosis, or consumption, by the family doctor.
Balintfy: Bryce Pinkham, an actor and writer in New York city, who read the Edmond character at the Georgetown University Hospital performance, explains how the family in this play is effective for getting audiences, especially healthcare professionals dealing with addiction, to connect with the issues of addiction and perhaps, real families.
Pinkham: So it's this just vicious complex family dynamic that strikes close to home to anyone who has a family. Granted, it is sort of at a theatrical pitch for most of the third act, but not that far off from family dynamics that we all, I think, recognize whether or not they have to do with addiction or other issues, which is why I think this project in particular succeeds in getting people to talk.
Baxter: One of the comments I made about this performance is that there didn't seem to be a lot of hope in what Eugene O'Neill wrote, and that's very different than my experience working with people with addictions.
Balintfy: That’s Dr. Jeff Baxter. He’s a family doctor and addiction treatment specialist at the University of Massachusetts Medical School, and an NIH grantee who helped guide the discussion among the medical professionals in the audience after the performance.
Baxter: I think the most powerful part of this experience was seeing the struggle so up close and personal and having it brought to life in a way that we might not have time to see it brought to life in our clinical practices where we can be rushed and often miss things like this.
Balintfy: The struggle in this theatrical performance was read by Harris Yulin as James Tyrone, the father, Pinkham as Eugene the youngest son, and Blythe Danner as Mary Tyrone, the mother. In this montage from the dramatic read, James and Edmund have returned from the bar, the other son Jamie, has not:
TYRONE: Oh, for the love of God! I’m a fool for coming home!
EDMUND: Papa! Shut up!
MARY: It was Edmund who was the crosspatch when he was little, always getting upset and frightened about nothing at all…
EDMUND: Maybe I guessed there was a good reason not to laugh.
TYRONE: Now, now, lad. You know better than to pay attention –
MARY: Who would have thought Jamie would grow up to disgrace us… Poor Jamie! It’s hard to understand. No it isn’t... You brought him up to be a boozer. Since he first opened his eye, he’s seen you drinking. Always a bottle on the bureau in the cheap hotel rooms! And if he had a nightmare when he was little, or a stomach-ache, your remedy was to give him a teaspoonful of whiskey to quite him.
TYRONE: So I’m to blame because that lazy hulk has made a drunken loafer of himself? Is this what I came home to listen to? I might have known! When you have the poison in you, you want to blame everyone but yourself!
EDMOND: Papa! You told me not to pay attention. Anyway, it’s true. You did the same thing with me. I can remember that teaspoonful of booze every time I woke up with a nightmare.
MARY: Yes, you were continually having nightmares as a child. You were born afraid. Because I was so afraid to bring you into the world.
Balintfy: Director Doerries says this play, in this format with discussion, is medical education:
Doerries: Part of what the play is saying is look how hard it is to sit in the room, look how hard it is to be in the presence of someone who is suffering and suffering from the disease of addiction. Now, let's talk about what tools, what resources, what strategies have worked for some of the physicians who have more experience in the room to help us to stay in the room, to get the patient narrative, to acknowledge and uncover the truth of the experiences surrounding their addiction. So we can then get those patients the treatment that they deserve and need so that they can recover and overcome their addiction.
Baxter: Treatment works.
Balintfy: Again, Dr. Baxter.
Baxter: What I hope the general public will be able to do is see their physicians and other healthcare providers as partners in working towards health and recovery. I find that patients are often reluctant to share problems they're having with substances because they're so stigmatized, and sometimes the providers aren't necessarily well prepared when they do bring that information forward. But I think we're all working towards the goal of a physician being able to really engage with people when they have these situations going on. So don't hold back. If your provider doesn't ask, please tell because then they'll be challenged to do their best to help you with those issues.
MARY: …My hands pain me dreadfully. I think the best thing for me is to go to bed and rest. Good night, dear.
TYRONE: Up to take more of that God-damned poison, is that it? You’ll be like a mad ghost before the night’s over!
MARY: I don’t know what you’re talking about, James. You say such mean, bitter things when you’ve drunk too much. You’re as bad as Jamie or Edmond.
Balintfy: Only a fraction of individuals who need specialty treatment for drug or alcohol addiction actually receive it each year. For example in 2009, more than 23 million people aged 12 or older needed it; but most—almost 21 million—did not get it. Research has demonstrated that screening and brief intervention can promote significant reductions in alcohol and tobacco use. A growing body of literature also suggests benefits of screening and brief intervention for illicit or nonmedical prescription drug use as well. For more information on the Addiction Performance Project and addiction research, visit www.nida.nih.gov.
Balintfy: And that’s it for this episode of NIH Research Radio. Please join us again on Friday, June 3 when our next edition will be available. Coming up then:
“Father’s Day is the perfect opportunity to celebrate Dads and encourage them to make improving their health a priority.”
If you have any questions or comments about this program, or have story suggestions of your own for a future episode, send me an email—my address is email@example.com. I'm your host, Joe Balintfy. Thanks for listening.
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