Valery Spiridonov set to be first for world’s first full HEAD transplant by Dr Sergio Canavero


  • Valery Spiridonov says he is ready to put his trust in Dr Sergio Canavero
  • 30-year-old computer scientist was born with Werdnig-Hoffman disease
  • Genetic muscle-wasting disorder has left him seriously disabled since birth
  • New body of city of Vladimir native would be taken from braindead donor
  • But 2016 target for operation is ‘pure fantasy’, say Dr Canavero’s critics 

A man with a fatal medical condition has spoken exclusively to MailOnline about how he is set to become the first person to undergo a head transplant and hopes it could be as soon as next year.

Valery Spiridonov says he is ready to put his trust in controversial surgeon Dr Sergio Canavero who claims he can cut off his head and attach it to a healthy body.

Mr Spiridonov, 30, a computer scientist from Russia, said: ‘My decision is final and I do not plan to change my mind.’

As a lifelong sufferer of the rare genetic Werdnig-Hoffman muscle wasting disease, he says he wants the chance of a new body before he dies.

Hope: Valery Spiridonov wants to be the first person to undergo a head transplant so he can have a shot at having a healthy body having suffered from the Werdnig-Hoffman muscle wasting disease

Hope: Valery Spiridonov wants to be the first person to undergo a head transplant so he can have a shot at having a healthy body having suffered from the Werdnig-Hoffman muscle wasting disease

Dnger: Mr Spiridonov said: 'I don't do this because I don't have a life but I think that science is developed by those who are ready to take risks and devote themselves to it'

Dnger: Mr Spiridonov said: ‘I don’t do this because I don’t have a life but I think that science is developed by those who are ready to take risks and devote themselves to it’

Controversial: Surgeon Dr Sergio Canavero claims all the necessary techniques already exist to transplant a head onto a donor body, despite widespread scepticism 

Controversial: Surgeon Dr Sergio Canavero claims all the necessary techniques already exist to transplant a head onto a donor body, despite widespread scepticism

‘Am I afraid? Yes, of course I am. But it is not just very scary, but also very interesting,’ said Mr Spiridonov from his home in Vladimir, a city 120 miles east of Moscow.

‘But you have to understand that I don’t really have many choices’, he said. ‘If I don’t try this chance my fate will be very sad. With every year my state is getting worse.’

Dr Canavero and Mr Spiridonov have talked via Skype though they have not met yet and the doctor has not reviewed his medical records.

The Italian told CNN he has received many email and letters from people seeking the procedure but he insists the first patients will be people suffering from a muscle wasting disease.

Dr Canavero has named the procedure HEAVEN, which is an acronym for head anastomosis venture. Anastomosis involves the surgical connecting of two parts.

He insists all the necessary techniques already exist to transplant a head onto a donor body.

The first monkey head transplant was performed 45 years ago and a basic operation on a mouse was carried out in China recently.

But critics say Dr Canavero’s plans are ‘pure fantasy’. The Italian has been compared to the fictional gothic-horror character Dr Frankenstein.

And Arthur Caplan, the director of medical ethics at New York University’s Langone Medical Centre, has described Dr Canavero as ‘nuts’.

Dr Hunt Batjer, president elect of the American Association for Neurological Surgeons, told CNN: ‘I would not wish this on anyone. I would not allow anyone to do it to me as there are a lot of things worse than death.’

The cost of the 36-hour operation, which could only be performed in the one of the world’s most advanced operating theatres, has been estimated at £7.5million.

The new body would come from a transplant donor who is brain dead but otherwise healthy.

Dr. Sergio Canavero predicts head transplantation is possible

History: In 1970 Dr Robert White transplanted the head of one monkey onto the body of another, as shown in this diagram. If Mr Spiridonov's head were to be successfully transplanted his jugular vein and spinal cords would have to be similarly fused with those of his new donor body

History: In 1970 Dr Robert White transplanted the head of one monkey onto the body of another, as shown in this diagram. If Mr Spiridonov’s head were to be successfully transplanted his jugular vein and spinal cords would have to be similarly fused with those of his new donor body

Both donor and patient would have their head severed from their spinal cord at the same time, using an ultra-sharp blade to give a clean cut.

The patient’s head would then be placed onto the donor’s body and attached using what Canavero calls his ‘magic ingredient’ – a glue-like substance called polyethylene glycol – to fuse the two ends of the spinal cord together.

The muscles and blood supply would be stitched up, before the patient is put into a coma for four weeks to stop them from moving while the head and body heal together.

When they wake the patient should be able to move, feel their face and even speak with the same voice. Powerful immunosuppressant drugs should stop the new body from being rejected.

Critics say Dr Canavero has simplified the difficulties involved in reattaching a spinal cord.

The Italian doctor has also so far failed to secure funding for the staff of 150 doctors and nurses he believes are required to complete the procedure.

 I would not wish this on anyone. I would not allow anyone to do it to me as there are a lot of things worse than death.
 Dr Hunt Batjer

However, the Italian is confident he can successfully transplant a head on to another body.

And if successful, his pioneering procedure could give new hope to thousands of paralysed and disabled people.

Mr Spiridonov was diagnosed with the rare muscle-wasting condition, Werdnig-Hoffman disease, at the age of one. Tragically the disease progresses every day.

He told MailOnline: ‘I can hardly control my body now. I need help every day, every minute. I am now 30 years old, although people rarely live to more than 20 with this disease.’

He continued: ‘My muscles stopped any development in childhood. Because of this, they do not grow and the skeleton gets deformed. The back muscles cannot support the skeleton.’

With his condition worsening each day, Mr Spiridonov is desperate for the technique to work. He told MailOnline: ‘If you want something to be done, you need to participate in it.

‘I do understand the risks of such surgery. They are multiple. We can’t even imagine what exactly can go wrong. I’m afraid that I wouldn’t live long enough to see it happen to someone else.’

He said his family fully support his decision to be the first human to undergo such surgery.

Mr Spiridonov added: ‘What’s more, there’s already a lot of effort invested in this idea and that’s why it’s too late to back out.

‘I came up with this idea quite some time ago. I read many scientific articles on this topic.

Planning: Mr Spiridonov has been talking through and planning the operation with Dr Canavero for two years

Planning: Mr Spiridonov has been talking through and planning the operation with Dr Canavero for two years

Mr Spiridonov says 'If you want something to be done, you need to participate in it'

Mr Spiridonov says ‘If you want something to be done, you need to participate in it’

‘The idea to transplant not only organs but the head has been studied for a long time even by Russian specialists. But an actual transplantation of the human head was never conducted.’

Mr Spiridonov contacted the controversial doctor, who is based at the University of Turin in Italy, after reading about his ambitious medical claims.

He said: ‘I contacted Professor Canavero two years ago after reading about his works. I offered myself to him to make this operation possible. We have never met and we just communicate via emails.

‘For the last two years we’ve been talking this idea through and planning the operation.

‘He’s a very experienced neurosurgeon and has conducted many serious operations. Of course he has never done anything like this and we have to think carefully through all the possible risks.’

The Russian has compared the pioneering procedure to the space race of the post-war years.

He said: ‘In the end it is like with astronauts. Before the first man we sent into space, 300 different scenarios of something going wrong were thought through but when he actually did it, it was the 301st scenario that happened.’

Mr Spiridonov denies his pledge to be a guinea pig is a stunt, and insists he goes into it with his eyes open.

‘If I want this kind of surgery to happen, I shouldn’t put the responsibility onto someone else but should try it on myself.

‘My family fully supports me. They also understand all the risks and even if they think that it’s too dangerous, they still support me in my decision.’

Despite his severe disabilities Mr Spiridonov has lead a full life, graduating from university with a degree in computer science.

SPINE ‘GLUED’ BACK TOGETHER

It is already 40 years since the first monkey head transplant and since then an operation on a mouse has been carried out in China.

But Dr Canavero claims all the necessary techniques already exist to carry out a full human head transplant.

He believes he just needs to put the relevant techniques together to carry out the first successful operation.

The new body would come from a normal transplant donor, who is declared brain dead.

Both the donor and the patient would have their head severed from their spinal cord at the same time, using an ultra-sharp blade to give a clean cut.

The patient’s head would then be moved on to the donor’s body and attached using a ‘glue’ called polyethylene glycol to fuse the two ends of the spinal cord together.

The muscles and blood supply would be stitched up, before the patient is put into a coma for four weeks to stop them moving while the head and body heal together.

During that time the patient would be given small electric shocks to stimulate their spinal cord and strengthen the connections between their head and new body.

As the patient is brought out of their medically-induced coma, it is hoped they would be able to move, feel their face, and even speak with the same voice.

Powerful immunosuppressant drugs would be prescribed to stop the new body from being rejected.

In addition, the patient would require intensive psychological support. 

‘I lost my father in a car crash 16 years ago,’ he told MailOnline. ‘He was a military man, a lieutenant colonel. So I had to start supporting the family at an early age.

‘My mother is a child psychologist in a rehabilitation centre for children who got into difficult situations.

‘I graduated from the Faculty of Information Technologies of Vladimir State University. I have a very active social life and I’m the head of a committee that deals with social policies for families and youth.’

He added: ‘I don’t do this because I don’t have a life but I think that science is developed by those who are ready to take risks and devote themselves to it.’

Mr Spiridonov has never discussed the possibility of failure with Dr Canavero.

He told MailOnline: ‘It was about me just offering myself as ready to undergo it. Of course, the professor considers the chances to succeed are quite high otherwise he wouldn’t try it.’

He says there is no ethical difference between transplanting a head on to a healthy body and replacing a damaged organ with a healthy one, which is now considered routine.

Donors could include victims of road traffic accidents or even prisoners sentenced to death, he says.

He told MailOnline: ‘I consider it to be as ethical as the transplant of the heart or kidneys. At some point of time this was considered to be unethical as well.

‘There was much talk about where the human soul is located, and if it’s ethical to do the heart transplants, but now doctors do it and save people’s lives.

‘I think it’s the normal way of technology to evolve. It would be strange to stop at this point when the neurosurgery is ready to take the next step.

‘The bodies used for transplant could be those of people whose brain was damaged, let’s say in a car crash or motorbike accident, or who are sentenced to capital punishment.

‘But, of course, in future humanity should learn how to grow healthy bodies for the transplants so there will be no shortage of organs and bodies.’

Mr Spiridonov says he understands that the Italian surgeon can only go ahead when he is satisfied that medical science is sufficiently advanced.

But the Russian he believes this moment is very close, possibly next year, 2016.

He told MailOnline: ‘We haven’t agreed on a particular date of the surgery with Dr Canavero,

Dr Canavero said his new body swap technique could help paralysed people such as Christopher Reeve

Dr Canavero said his new body swap technique could help paralysed people such as Christopher Reeve

‘It’s an ongoing process and a lot depends on the success of the studies that are underway now.

‘There will be a conference of neurosurgery in Annapolis in the US this summer. The professor will be reporting on his studies there.

‘He would like me to be present. I would like to attend if I can find the means to fly there. We will see what the next step is after that.’

Matter-of-factly, he adds: ‘For now we are thinking about transplanting my head in 2016.’

The Russian even jokes about what might happen if the surgery goes wrong.

He told MailOnline: ‘Maybe I would try to move my leg but instead my body will produce a litre of adrenaline. But I am willing to take the risks and try.’

In 1970 Dr Robert White transplanted the head of one monkey onto the body of another at the Case Western Reserve University School of Medicine.

The monkey died after eight days because the body rejected the head. The monkey was unable to breathe on its own. The animal could not move because the spinal cord were not connected.

Dr Batjer says White’s research does not provide evidence that a human head transplant can work.

He told CNN: ‘It’s a 45-year-old reference in a primate and there is no evidence that the spinal cord was anastomosed functionally.’

 

Medical Doctors Ranked First with Highest IQ amongst job professions


How Smart are Medical Doctors? An interesting study published by the University of Wisconsin suggests that doctors (M.D or equiv O.D, dents, etc) have the highest IQ on average.

Though I’m not a huge supporter of IQ tests but I would say that most doctors are somewhat smart. However, I would further add that, having a high IQ does NOT make good doctor.
Being a good doctor requires more than just book smarts. It requires strong work ethics, commitment and clear communication skills. Understanding basic science and pathology requires you to be smart. Facing death and the sickness of others requires human compassion.
A often neglected, but perhaps more important measurement is Emotional intelligence. Doctors with high EQ care for their patients better.
Medicine is both a science and an art. Doctors have to understand bio-mechanisms and lab tests as well as human emotions and feelings. People who are aware of their own emotions and can empathize with others will be more likely to give excellent patient care.

Unfortunately, the ever increasing emphasis on test scores (GPA, MCAT, USMLE) may be a bad sign for our future doctors. We are increasing our IQ statistics but consistently neglecting our EQ measurements. Medical schools have acknowledged these problems and have begun pushing for more arts and humanities in medicine.

People don’t care how much you know–until they know how much you care.

A higher EQ is beneficial for doctors too. A patient is more likely to trust their physician and disclose information if they know their thoughts and ideas will be respected. Even though medical knowledge is growing exponentially and as physicians, we will continually learn medicine, we must not neglect our emotional education either. Doctors treat patients, not diseases.

Doctors planning the first human head transplant


head
A team of elite surgeons from around the world will soon be attempting a medical first — a full human head transplant. No, this is not a movie, sci-fi novel, or tragically late April Fools’ prank. This is actually happening, and no one knows if it will work or what it could mean if it does.

The patient (read: guinea pig) is a 30-year-old Russian man named Valery Spiridonov. He’s not just doing this for fun, though. Spiridonov has a terminal form of spinal atrophy called Werdnig-Hoffman disease. There’s no known medical treatment that will save his life, except maybe taking his head off and placing it on a different, healthier body.

Italian surgeon Sergio Canavero will be in charge of decapitating and re-capitating Spiridonov, following a procedure laid out in a paper published in the journal Surgical Neurology International. The operation is expected to take 36 hours and require 150 medical staff.

First, Spiridonov’s head and new body will be cooled to slow the rate of cell decomposition. Then, doctors will hook up all the major blood vessels in the neck to machines that will keep things flowing during the transfer. The spinal cord will then be severed and the head will be moved to the new body for attachment. Canavero plans to use polyethylene glycol injections to get the cells and connective tissues to stick together, binding the head to the new body. After that, it’s simply a matter of connecting blood vessels, muscles, and nerves.

Doctors expect it will take up to a year for Spiridonov’s spinal cord to completely fuse with the new body, but that’s far from the only potential complication. No one really knows what switching bodies will do to the brain. The exposure to completely different chemical and electrical signals could drive a man mad. There’s also the possibility the new body will reject Spiridonov’s head, even with powerful anti-rejection drugs.

The project will officially launch in June as Canavero begins recruiting staff for the procedure. It could take place as early as next year. If this doesn’t work, there’s always the Futurama-style head in a jar.

Being fat in middle age reduces risk of developing dementia, researchers say


April 10
A surprising study contradicting all previous research found that being fat in middle age appears to cut the risk of developing dementia rather than increase it, the Lancet scientific journal has reported.A study of two million people found that the underweight were far more likely to develop dementia, a growing problem among the elderly in the Western world.Underweight people had a 34 percent higher risk of developing dementia than those of a normal weight, the study found, while the very obese had a 29 percent lower risk of becoming forgetful and confused and showing other signs of senility.

Obesity levels, like dementia levels, are soaring worldwide.

Researchers said that if other studies confirm the findings, the next step would be to examine if people who eat more unknowingly take in dementia-fighting nutrients in the extra food they consume.

 The study, published in the Lancet Diabetes and Endocrinology Journal, flies in the face of previous smaller studies — and much modern health advice — that what is good for the heart is also good for the head.

A 2008 study of 6,000 people published in the Neurology journal found that people who have big bellies in their ’40s were much more likely to get Alzheimer’s and other forms of dementia in their ’70s. That study was among the first to link middle-aged spread to a fading mind.

But the new research “overshadows those (previous studies) by orders of magnitude,” said Nawab Qizilbash of Oxon Epidemiology, who led the study. “We show completely the opposite,” Qizilbash said, as quoted by the Times of London.

Patients were an average 55 years old and 45,507 of them developed dementia over an average of nine years. The risk of dementia fell steadily as their weight rose, the researchers found.

Qizilbash, as quoted in the Times, said the findings held despite attempts to adjust it for other causes of dementia and the tendency of obese people to die earlier.

“We did a lot of analysis to see if we could explain it but it just seems to persist. We couldn’t get rid of it, so we’re left with this apparent protective effect,” the scientest was quoted as saying.

The co-author of the paper said the results suggested “that doctors, public health scientists and policymakers need to re-think how to best identify who is at high risk of dementia.”

 “If we can understand why people with a high body mass index have a reduced risk of dementia, it’s possible that further down the line, researchers might be able to use these insights to develop new treatments,” Stuart Pocock of the London School of Hygiene and Tropical Medicine was quoted as saying by the London newspaper.

Qizilbash warned, however, that being overweight or obese brings with it a much higher risk of death from any cause and a higher risk of stroke and other diseases.

“So even if there is a protective effect against dementia from being overweight or obese, you’re not living long enough to benefit from it,” Qizilbash was quoted as saying by the Times.

This is What Happens To The Body When You Eat Pink Himalayan Salt .


salt-thumb

Pink salt is a salt that is found in the Himalayan mountains in a range stretching across Asia through China, Nepal, Myanmar, Pakistan, Bhutan, Afghanistan, and India.

Why is it pink?

The different hues of pink, red, and white are an indication of the salt’s rich and varying mineral and energy-rich iron content.

Pink Himalayan crystal salt contains all of the 84 elements found in your body, just to name a few: sodium chloride, sulphate, calcium, potassium, and magnesium.

So, why should I use this instead of my normal salt?

Some of the benefits that you can expect by consuming this salt in place of regular table salt include:

Aiding in vascular health

Supporting healthy lungs and respiratory function

Promoting a stable pH balance within the cells

Reducing the signs of aging

Promoting healthy sleep patterns

Strengthen bones

Lowers blood pressure

Improves circulation

Detoxifying the body of heavy metals

Promote healthy pH balance in your cells

Regulate the water content throughout your body

Iodine- Natural salts, like pink salt, are rich in iodine. This means that it does not need to be artificially added in.

 Less sodium- Yes, I know, that sounds strange, but Himalayan salts are mineral packed crystals. They are formed naturally in the earth made up of 85.62% sodium chloride and 14.38% other trace minerals like sulphate, bicarbonate, bromide, and strontium.

Himalayan salt can:

Create an electrolyte balance

Increase hydration

Prevent muscle cramping

Balance the Ph (alkaline/acidity) and help acid reflux.

Why it is better than table salt:

Conventional table salt is completely stripped of a good majority of its minerals with the exception of sodium and chloride. It is bleached, cleaned with chemicals and then heated to an extremely high temperature. Then the iodine is added in that is almost always synthetic that is quite difficult for our bodies to take in. Many studies have shown that for each gram of table salt consumed the body cannot process, your body will use 20 times the amount of cellular water to neutralize the amount of sodium chloride that is presented.

The best part is…

Versatility! That’s right, it can be used for more than just its food seasoning properties.

Air Purifier- crystal rock lamps make wonderful air-purifiers!

Bathing- throw a handful into the bath tub for a detoxifying Himalayan salt bath. The replenishing nutrients help to stimulate circulation and soothe sore muscles.

Decoration- they make lovely food decoration; you can also buy salt slabs to present your food on as well as lamps and holders!

Believe me, once you make this investment you will never go back!

Sources:

http://skinnywithfiber.org/8-surprising-benefits-of-pink-himalayan-salt/

http://empoweredsustenance.com/himalayan-salt-benefits/

http://www.gaiahealthblog.com/2012/01/16/himalayan-vs-sea-salt/

11 Life Changing Lessons to Learn from Buddha


1. Thoughts and words have power. They can either hurt or heal. Choose wisely.

“Words have the power to both destroy and heal. When words are both true and kind, they can change our world.”
– Buddha

All that we are is the result of what we have thought. The mind is everything. What we think we become.”
– Buddha

“Whatever words we utter should be chosen with care for people will hear them and be influenced by them for good or ill.”
– Buddha

“You will not be punished for your anger, you will be punished by your anger.”
– Buddha

“All wrong-doing arises because of mind. If mind is transformed can wrong-doing remain?”
– Buddha

“We are shaped by our thoughts; we become what we think. When the mind is pure, joy follows like a shadow that never leaves.”– Buddha

“He is able who thinks he is able.”
– Buddha

2. There is an abundance for all. Happiness never decreases by being shared.

“Thousands of candles can be lit from a single candle, and the life of the candle will not be shortened. Happiness never decreases by being shared.”
– Buddha

 

3. Let go of fear.

“The whole secret of existence is to have no fear. Never fear what will become of you, depend on no one. Only the moment you reject all help are you freed.”
– Buddha

 

4. The truth will always be revealed. Always believe your own truth.

“Three things cannot be long hidden: the sun, the moon, and the truth.”
– Buddha

“Believe nothing, no matter where you read it or who has said it, not even if I have said it, unless it agrees with your own reason and your own common sense.”
– Buddha

“Do not believe in anything simply because you have heard it. Do not believe in anything simply because it is spoken and rumored by many. Do not believe in anything simply because it is found written in your religious books. Do not believe in anything merely on the authority of your teachers and elders. Do not believe in traditions because they have been handed down for many generations. But after observation and analysis, when you find that anything agrees with reason and is conducive to the good and benefit of one and all, then accept it and live up to it.”
– Buddha

 

5. You, yourself, deserves your love and affection. Self love is the most deserving love.

“You can search throughout the entire universe for someone who is more deserving of your love and affection than you are yourself, and that person is not to be found anywhere. You, yourself, as much as anybody in the entire universe, deserve your love and affection.”
– Buddha

 

6. We are all spiritual beings in need of a spiritual life that nourishes the soul.

“Just as a candle cannot burn without fire, men cannot live without a spiritual life.”
– Buddha

“The way is not in the sky. The way is in the heart.”
– Buddha

“To conquer oneself is a greater task than conquering others.”
– Buddha

“The only real failure in life is not to be true to the best one knows.”

– Buddha

7. True peace comes from within. Peace is the answer.

“Peace comes from within. Do not seek it without.”
– Buddha

“Better than a thousand hollow words, is one word that brings peace.”
– Buddha

“Those who are free of resentful thoughts surely find peace.”
– Buddha

 

8. Choose friends wisely.

“An insincere and evil friend is more to be feared than a wild beast; a wild beast may wound your body, but an evil friend will wound your mind.”
– Buddha

“A good friend who points out mistakes and imperfections and rebukes evil is to be respected as if he reveals a secret of hidden treasure.”
-Buddha

 

9. Remove separation and give up labels. We are all ONE.

“In the sky, there is no distinction of east and west; people create distinctions out of their own minds and then believe them to be true.”
– Buddha

“Unity can only be manifested by the Binary. Unity itself and the idea of Unity are already two.”
– Buddha“He who experiences the unity of life sees his own Self in all beings, and all beings in his own Self, and looks on everything with an impartial eye.”
– Buddha

10. Happiness is the journey, not the destination. Enjoy the journey.

“There is no path to happiness: happiness is the path.”
– Buddha

“A jug fills drop by drop.”
– Buddha

It is better to travel well than to arrive.”
– Buddha

 

11. Health is Wealth!

“Every human being is the author of his own health or disease.”
– Buddha

“To keep the body in good health is a duty…otherwise we shall not be able to keep our mind strong and clear.”
– Buddha

“Health is the greatest gift, contentment the greatest wealth, faithfulness the best relationship.

– Buddha

BONUS: Replace hate or jealousy with love and admiration.

“Do not be jealous of others’ good qualities, but out of admiration adopt them yourself.”
– Buddha

“Hatred does not cease by hatred, but only by love; this is the eternal rule.

– Buddha

buddha

 

Diabetes in Midlife Linked to Faster Cognitive Decline


Diabetes in midlife is associated with an increased rate of cognitive decline over a 20-year follow-up, a new study shows.

And while patients with diabetes at midlife had a steeper cognitive decline than patients without diabetes, greater loss of cognitive function was also seen for patients who had prediabetes with only modestly raised blood glucose levels.

“These data suggest that primary prevention of diabetes or glucose control in midlife may protect against later-life cognitive decline,” the authors conclude.

The effect was greater for patients with a longer duration of diabetes, highlighting the importance of intervention as early as possible.
“The implication is that we have seen over a 20-year period what happens before the development of dementia,” coauthor A. Richey Sharrett, MD, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, commented to Medscape Medical News. “This gives patients and care providers a window of opportunity to do something about it.”

Diabetes can be prevented in some cases or at least delayed by lifestyle improvements, and when diabetes has already occurred, it can be controlled, he added. “Our results give additional reasons to do this. People dread dementia more than anything else. The idea that dementia can be delayed or reduced is a strong motivator. This is a pretty good reason to keep blood sugar in control.”

The findings are published online December 2 in Annals of Internal Medicine.

A “Window of Opportunity”

The study, lead by Andreea M. Rawlings, MS, also at Johns Hopkins, analyzed data from the Atherosclerosis Risk in Communities (ARIC) study, which prospectively followed 15,792 middle-aged adults from 1987 to 2013.
The current analysis is based on 13,351 participants (mean age at baseline, 57 years); 56% were female, 24% were black, and 13.3% had diabetes.

Cognitive testing was performed at visit 2 (1990 to 1992), visit 4 (1996 to 1998), and visit 5 (2011 to 2013) and involved three tests: the Delayed Word Recall Test, the Digit Symbol Substitution Test of the Wechsler Adult Intelligence Scale-Revised, and the Word Fluency Test. From these, a global cognitive Z score was calculated.

Blood glucose levels were calculated as hemoglobin A1c (HbA1c) values from stored whole blood samples.

Of the initial cohort, 17% did not attend any follow-up visits, leaving 10,720 individuals who attended visit 4 and 5987 who attended visit 5. The median duration of follow-up was 19.3 years.

Results showed that individuals with diabetes had a 19% greater decline in global cognitive Z score: a decline of 0.92 vs 0.78 for persons without diabetes (a difference of 0.15).

The authors estimate that this difference in Z score is equivalent to an age difference of 4.9 years older or the difference in cognitive performance of a 60-year-old person vs a 55-year-old person if they are otherwise similar.

 Persons without diagnosed diabetes but with an HbA1c level of 5.7% to 6.4% at baseline also had significantly more cognitive decline over 20 years (adjusted difference in global cognitive Z score of –0.07) than persons with an HbA1c level less than 5.7%.

The greatest decline was found in patients with poorly controlled diabetes, defined as an HbA1c level of at least 7.0%, who had a larger decline than those with better controlled diabetes with an HbA1c level less than 7.0% (adjusted global Z score difference, –0.16; P = .071).

Diabetes duration seemed to be a factor, with a greater cognitive decline late in life for participants with longer-duration diabetes.

“Critical Aspect of Successful Aging”

“Maintaining cognitive function is a critical aspect of successful aging and ensuring a high quality of life,” the authors write. “Diabetes and glucose control are potentially modifiable and may offer an important opportunity for the prevention of cognitive decline, thus delaying progression to dementia. At the population level, delaying the onset of dementia by even a couple of years could reduce its prevalence by more than 20% over the next 30 years.”

Dr Sharrett explained to Medscape Medical News that other studies have linked diabetes to dementia but that this is the largest, with the longest follow-up.

“But what really sets it apart from other studies is that we measured change in cognition over time in diabetics and nondiabetics using the same tests in a standardized way,” he said. “This gives us assurance that our findings are real. In fact, I would say we are sure they are conservative.”

The study did not address possible mechanisms, although exclusion of persons who had a stroke after baseline attenuated the results slightly, suggesting that stroke partially mediates the association.

Dr Sharrett suggested that elevated blood glucose could affect cognition in different ways. While there is obviously a link between diabetes and vascular disease that could lead to vascular dementia, he believes that raised blood glucose levels may also affect the Alzheimer’s type of dementia.

“There is substantial controversy as to whether diabetes affects β-amyloid deposits or tangles that are the classical hallmarks of Alzheimer’s dementia,” he commented.

“It is difficult to ascertain what the cause of dementia is,” he added. “Postmortem studies have shown that both Alzheimer’s and vascular pathology can often be present. While it is often thought that most dementia is related to Alzheimer’s disease and there has been disappointment that we haven’t been able to delay or prevent this yet, there is a sizable portion of dementia that is related to the vasculature and we can do something about that.”

“Our observations that diabetes duration and even prediabetes [are] associated with faster cognitive decline emphasize the importance of adopting a healthy lifestyle as soon as possible,” he concluded.

LifeVest ‘Wearable Defibrillator’ a Cost-Effective Bridge After ICD Removal for Infection


For patients who have undergone the successful removal of their implantable cardioverter defibrillator (ICD) because of an infection, the use of a wearable cardioverter defibrillator (LifeVest, Zoll) is a cost-effective treatment strategy for preventing sudden cardiac arrest (SCA) while patients wait for another device, according to a new analysis[1].

“The decision regarding when to reimplant must be individualized to each patient and clinical situation,” state Drs Christopher Healy and Roger Carrillo (University of Miami Miller School of Medicine, FL). “For many patients, continuous inpatient monitoring may be impossible or at least highly undesirable. The wearable cardioverter defibrillator is likely a cost-effective treatment modality for the prevention of SCA in a significant number of these at-risk patients.”
Writing in Heart Rhythm March 31, they note that a patient is typically given antibiotics for several weeks following the extraction of an infected device. If a second device is put in too soon, there is a risk of repeat infection. While the device is out, however, there is a risk of SCA. For the patient, continuous monitoring is impractical and, for the hospital, expensive.

In the present analysis, outpatient use of the wearable defibrillator cost $1805 more but resulted in better clinical outcomes compared with a strategy of discharging the patient home without a wearable or implanted defibrillator. Based on a 5.6% risk of sudden cardiac death within the first 2 months (4.0% risk within the first month), 0.089 life-years were gained with the wearable defibrillator, yielding an incremental cost-effectiveness ratio (ICER) of $26 436 per quality-adjusted life-year (QALY) gained.

As with all economic analyses, the researchers made some assumptions. Their base-case scenario assumed the wearable defibrillator was 84.5% effective in terminating potentially fatal ventricular tachyarrhythmias. If the efficacy of the defibrillator increased to 95%, the ICER was as low as $15 392/QALY. If efficacy declined below 69%, the wearable defibrillator would no longer be considered cost-effective as it would exceed $50 000/QALY.
The wearable defibrillator was also cost-effective as long as the time to reimplantation of the replacement ICD was at least 2 weeks.

In addition, researchers report the wearable device was cheaper than discharging patients to a nursing facility or leaving them in the hospital and also had better clinical outcomes. As a result, the wearable defibrillator was considered a “dominant” strategy against these two treatment options.

Simple Intravenous Fluid Could Save Many Ebola Patients, Specialists Say


Simple intravenous fluid drips could save the lives of many West African Ebola patients, but are being neglected because of a perception that there is no effective treatment for the disease, specialist doctors said on Friday.

“Ebola treatment centers must be more than just a setting for quarantine,” Ian Roberts of the London School of Hygiene and Tropical Medicine and Anders Perner of Copenhagen University wrote December 6 in The Lancet. “Patients will be reluctant to attend treatment centers unless the care they receive … is superior to the care provided by family members.”

West Africa’s Ebola epidemic, by far the largest on record, has killed more than 6,000 of the 17,000 or so people infected so far, according to the World Health Organization. Guinea, Liberia and Sierra Leone account for all but 15 of the deaths.

But many patients are probably dying not from the disease’s signature hemorrhaging, but from extreme dehydration and electrolyte depletion caused by nausea, vomiting and diarrhea, the scientists wrote.

The fact that there is no proven vaccine or drug cure has led to the “widespread misconception” in the worst-hit countries that no treatment is effective, Roberts and Perner said.

“Whereas many patients … receive oral rehydration and some electrolyte substitution, the use of intravenous fluids and electrolytes varies, and it is likely that many patients die from deficiencies in fluid volume and electrolytes.”

Assisted-Suicide Ban Struck Down in Canada


In another sign of the burgeoning death-with-dignity movement, the Supreme Court of Canada today struck down that nation’s ban on assisted suicide, calling it a violation of the constitutional “right to life, liberty, and security of the person.”

Canada’s high court said it was swayed by evidence showing that physician-assisted suicide laws in Oregon, Washington, and several European countries protect vulnerable individuals who are not competent, or who could be pressured into taking their lives by greedy relatives. The court suspended its lifting of the assisted-suicide ban for one year to give the Canadian parliament time to draft a law like Oregon’s, which has been a template for other states and nations.
The Oregon law permits a physician to prescribe a lethal drug to a terminally ill adult who requests it, provided certain prerequisites are met, such as counselling on palliative and hospice care, and a determination of competence and independent decision-making. Canadian lawmakers may not necessarily limit physician-assisted suicide to terminally ill patients, however, given the ruling by the Supreme Court of Canada. The justices extended the right to die this way to competent adults with a “grievous and irremediable medical condition that causes suffering that is intolerable to the individual.” Terminal illness, defined in the Oregon law as one that likely gives the person only six months to live, does not enter into the court’s formula.

The case before the Supreme Court of Canada involved two women who together with their families challenged the ban on assisted suicide in a British Columbia trial court. One of the women, Gloria Taylor, was dying of amyotrophic lateral sclerosis.

“What I fear is a death that negates, as opposed to concludes, my life,” the supreme court ruling quotes Taylor as saying. “I do not want to die slowly, piece by piece. I do not want to waste away unconscious in a hospital bed. I do not want to die wracked with pain.”
The other plaintiffs were the daughter and son-in-law of Kay Carter, who had spinal stenosis. The couple took Carter to a Swiss assisted-suicide clinic, where she died, and then joined Taylor in the lawsuit. The trial court ruled in their favor and exempted Taylor from the assisted-suicide ban. She never took advantage of it, dying of an infection instead. The attorneys general of Canada and British Columbia contested the decision in an appeals court and won. That set the stage for the supreme court decision.

Canadian Medical Association Will Support Physician Conscience

The eventual lifting of the assisted-suicide ban will be a moment of truth for Canadian physicians. The Canadian Medical Association (CMA) states as a matter of policy that physicians should not participate in assisted suicide, but only because it is illegal. In a brief filed in the supreme court case, the CMA said that if the law were to change, it “would support its members who elect to follow their conscience.”

The medical society noted in its brief that some of its members oppose physician-assisted suicide, or aid-in-dying, as it is called in the death-with-dignity movement, as a violation of the traditional medical injunction to do no harm. Other physicians, it said, support assisted suicide because of the “equally established principle” of considering patient well-being and autonomy.

“The CMA accepts that…it would not be appropriate for it to seek to impose or advocate for a single standard for the medical profession,” the association said.

Its stance, by and large, contrasts with that of organized medicine in the United States. The American Medical Association opposes physician-assisted suicide, as do some of its affiliates in states that have legalized the practice, or voted it down. However, rank-and-file physicians here, like their Canadian peers, are divided on the issue. In a Medscape ethics survey last year, 54% of physicians said they support assisted suicide, up from 46% in 2010. Thirty-one percent said they opposed it, while another 15% said “it depends.”

The Risks Can Be Limited, Says Canada’s High Court

Today’s decision by the Supreme Court of Canada reverses a 1993 ruling in which it upheld the ban on assisted suicide. In its latest ruling, the court noted the spread of assisted-suicide laws since 1993, beginning with Oregon’s in 1994. Washington and Vermont have followed Oregon’s legislative lead. Physician-assisted suicide also is legal in Montana because its supreme court ruled that nothing in state law prohibits the practice.

Meanwhile, bills legalizing physician-assisted suicide have been introduced, or promised, in some two dozen states, including California, according to the aid-in-dying group Compassion and Choices. A group of physicians and patients in New York this week asked a state court to declare that physician-assisted suicide is not against the law.

Countries where physician-assisted suicide is legal include Switzerland, Belgium, Luxembourg, and the Netherlands. The last three countries have gone one step further to permit euthanasia, in which someone actively administers a death-dealing agent, as opposed to just prescribing it. Parliament’s House of Lords in the United Kingdom is considering an Oregon-style bill legalizing physician-assisted suicide, which the British Medical Association opposes.

Opponents of physician-assisted suicide contend that legalizing it endangers vulnerable citizens such as the elderly or those with disabilities who may be pressured or manipulated into ending their lives. In addition, some people may irrationally seek a physician’s help in dying, given a cognitive impairment, depression, or some other mental illness. However, the Canadian supreme court agreed with the trial court that physician-assisted suicide laws like that in Oregon has curtailed such abuses and missteps.

“The risks associated with physician-assisted suicide,” the high court stated, “can be limited through a carefully designed and monitored system of safeguards.”