2008年05月 | ARCHIVE-SELECT | 2008年07月


Still Sexy After 60 #4/4 ( By TIME - jan. 19. 2004 )

The emphasis, in any event, may be as much on a caring relationship as it is on sex. Both widowed and both 87, Hilde and Joe met through relatives, took to each other and decided to set up joint housekeeping--though, at her insistence, only on weekends. "We had our lovefests at my place," says Hilde, a lively community volunteer in Tamarac, Fla., a suburb of Fort Lauderdale. "But on Mondays I'd send him packing." Recently Joe suffered a mild stroke. Refusing to go into a nursing home, he moved into a little house across from Hilde's. She got it furnished, makes him dinner and continues to enjoy his companionship. "He still likes his sex," she says with a laugh, "though I'm not back yet at my old energy level because of all the work." Ettie and Ben Kranz of Cleveland, Ohio, have had a somewhat different experience. In their 68-year marriage, they had plenty of good sex until his 86 years finally caught up with him. "Our lives aren't the same, but we complement each other," says Ettie, who at 89 still drives around town, shops, cooks, bakes and tends to him. "He's my child now."

Even nursing homes are finding they must adjust to late-blooming love and its attendant complexities. In a forthcoming book, Stella Henry, a Los Angeles geriatric nurse and bioethicist, describes the very different family reactions to a romance between two pseudonymous residents--Jack, 92, and Jill, 86--in a Los Angeles-area long-term-care facility. While the man's family gave its blessings, the woman's relatives were appalled. Henry, reflecting the enlightened view of a new generation of caregivers, is sympathetic to late-December pairings as long as both partners still have their wits and the relationship doesn't disturb other residents.

Because men are often outnumbered in senior homes, they may be subjected to a lot of attention. Nancy, 83, a very proper widow who had just arrived at an upstate New York senior residence, recalls casually accepting a ride one fall afternoon from a fellow resident, a lively gent who wanted to show her the countryside. The next evening at cocktail hour, Nancy was taken aside and told in no uncertain terms by another widow that the man was already taken. "I thought I was back in a high school locker room," recalls Nancy, astonished by the woman's aggressiveness. Sexual games among the senior set can also have a happier outcome, of course. Discovering each other via the Internet, old high school sweethearts Barbara MacLeod and Bill Jessup, both 77 and living in Miami, got married last March and found, in his words, "we can teach something to newlyweds" about sex. He loves chasing Barbara around the house, he says, though happily for him, "she won't run that much."

Innocent fun or not so innocent, senior sexuality still ruffles feathers in a society that prefers not to acknowledge its existence. Many doctors won't even bring the subject up with older patients. "That affection is subject to ridicule seems just wrong, ageist," says Butler.

But attitudes are changing. "To be bodily close again, to enjoy whatever the aging process allows, is one of the greatest blessings I know," a woman, 73, tells sex educator Eric Johnson. "Grow old along with me," the Victorian poet Elizabeth Barrett Browning wrote to her new husband Robert Browning when she was 40, he was 34, and open expression of sexual desire was unheard of in polite society. "The best," she promised, "is yet to be." We're only beginning to learn how right she was. --With reporting by Kathie Klarreich/Miami and Wendy Malloy/Tampa

With reporting by Kathie Klarreich/Miami and Wendy Malloy/Tampa


| TIME | 06:02 | comments:0 | trackbacks:0 | TOP↑


Still Sexy After 60 #3/4 ( By TIME - jan. 19. 2004 )

Most gerontologists recommend exercise and a healthy lifestyle as a far better route to prolonged sexual happiness. Says Dr. Jeffrey M. Drazen, editor in chief of the New England Journal of Medicine: "You're better off spending your money at a gym." Heeding his own advice, Butler, 76, the former director of the National Institute on Aging and founder of the International Longevity Center in New York City, and his wife, 64, exercise daily, stressing aerobic fitness, strength, flexibility, balance and posture. On weekends they go off with a walking group. And their sex life? "Just great," says Butler.

Workouts of the imagination can help too. "Take a vacation; make out in the car," sex therapist Cynthia Lief Ruberg, co-author of Pathways to Pleasure (PEC Publishing; 223 pages), tells elderly clients who complain they're in a rut. Or try new ways of doing the same old thing. In Married Lust: 10 Secrets of Long-Lasting Desire (Hearst Books; 224 pages), Pamela Lister and the editors of Redbook prescribe new sex positions, from tender to kinky, as "a perfect antidote to the encroaching dullness of routine." (Their survey shows women favor the missionary position, while men tend to want the woman on top.)

As for balky erections, Viagra alone may not suffice. "Men feel they're expected to perform, which can create a situation called spectatoring," explains Tampa's Dr. Saks. "Rather than being in the game and enjoying the passion, you become a spectator, watching and observing and anxious, worrying about your performance and your partner's acceptance. You can't get an erection even with Viagra." One answer may be more direct stimulation by a sympathetic, caring partner. "You have to start slowly, with touching, and take the pressure off," says Saks. "People make sex too much work."

That's a lesson the aging sometimes forget. Too often they fail to appreciate their own sexual needs or powers, succumbing to old myths about declining sexuality. Freud was sure female sexuality ended at menopause--a time, he huffed, when women become petty, stingy and sadistic and acquire other "anal-erotic" traits. But the evidence suggests quite the opposite. "Many [seniors] still want and seek orgasms when they're in their 70s and 80s," says Dr. Kevan Namazi, former chair of the gerontology department at the University of Texas Southwestern Medical Center at Dallas.

But satisfaction can come in unexpected ways. As Peggy Brick, co-author of New Expectations, a frank handbook for sex counselors for seniors from SIECUS (the Sexual Information and Education Council of the United States), points out, "What's appropriate sexual behavior for a 21-year-old is not appropriate for a 70-year-old." Given the diminished male ability to produce erections, many older couples rely on what sex counselors call "outercourse." Instead of penetration, says Brick, who at 75 remains an active sex educator, outercourse involves other types of pleasuring, such as touching and cuddling. "[Without] the pressure on men to produce an erection," she says, "[sex] can be much more satisfying."

| TIME | 17:00 | comments:0 | trackbacks:0 | TOP↑


Still Sexy After 60 #2/4 ( By TIME - jan. 19. 2004 )

Nowadays doctors can help many of them. Since Viagra's ballyhooed debut in 1998, the little blue pills and their progeny (Levitra and Cialis) have been doled out--thanks in part to former Senator Bob Dole's TV huckstering--by the millions. They have been a boon for countless men (and, one hopes, their partners) while reducing demand for penile implants and other awkward mechanical aids. "We took Mr. V on our cruise," an elderly couple recently wrote Tampa, Fla., sex therapist Bonnie Saks from their post-counseling trip. "Had a great time. Thank you very much." Still, these wonder drugs won't do any good if there is no sexual urge in the first place or if other health conditions impair erectile function. As Saks points out, "The medications won't initiate libido. The desire has to be there already in order for them to work."

Yet sexual dysfunction isn't just about male impotence. Both sexes experience failures as they age. And any number of health factors may be at fault, including poor circulation, diabetes, high blood pressure, heart disease, stress and alcoholism--to say nothing of the medications often prescribed for them. For women, the problem is often a decline in estrogen at menopause, usually around age 50. That may cause disconcerting hot flashes as well as dryness and a thinning of the vaginal wall that can make intercourse unpleasurable, if not painful. Production of the male sex hormone testosterone--which occurs in both sexes--also drops, and with that may come a diminished interest in sex. Finally, as wrinkles and cellulite accumulate, they can affect a woman's self-image. She may not only feel less desire, she may feel she's less desirable to her partner, who by this time is probably having self-image and performance problems of his own.

For women, there are no magical routes to arousal. So far, Viagra-type drugs haven't worked for them. On the contrary, an indifferent partner who suddenly becomes amorous can ruin a relationship. Divorce lawyers talk these days about Viagra affairs and split-ups. Some doctors are prescribing testosterone as a libido booster for so-called low-T women, helping push up testosterone sales some 17 times in the past decade to about $400 million annually. Variously given as a pill combined with estrogen or as a patch, cream or injection, testosterone remains unproven as a sex aid. Meanwhile, it can cause oily skin, unwanted facial hair, a lowered voice and an upsetting onslaught of sexual fantasies.

But these risks haven't slowed the run on sex-enhancing nostrums, from herbal supplements like horny goat weed to topical Viacreme, many of them sold on the Web. How good are they? Probably not much better than the monkey testicles worried men had sutured onto their own testicles in the 1920s. ConsumerLab, a White Plains, N.Y., testing firm, found when it sampled Web-peddled human growth hormone (HGH) supplements that they contained no more HGH than a hamburger.


| TIME | 16:14 | comments:8 | trackbacks:0 | TOP↑


Still Sexy After 60 #1/4 ( By TIME - jan. 19. 2004 )

They are not yet eligible for Social Security or Medicare, but you can tell from their sagging chins, receding hairlines and growing paunches that they are on the verge of major changes in mind and body. Yes, America's 77 million baby boomers are coming of age--old age. In two years the first offspring of the post--World War II generation (born from 1946 to 1964) will turn 60. What will that mean for the sons and daughters of the Age of Aquarius? Will passion diminish? Will performance decline or (gasp!) wither away?

Well, kids, take it from someone who has collected his first Social Security check: the sexual impulse doesn't vanish with age, even if--how to say this delicately?--execution sometimes falters. There's plenty of evidence--scientific and otherwise--that healthy seniors, even residents of nursing homes, continue to have active sex lives. Consider the decision of a Riverdale, N.Y., senior home to permit trysts among clients as long as they are consensual. Or the buzz about the film Something's Gotta Give, in which Jack Nicholson plays a 62-year-old roue who boasts of never having had sex with a woman over 30, only to free-fall for Diane Keaton, his latest girlfriend's mom, still steamy in her 50s.

And why not? Without fear of an unwanted pregnancy--or worries about kids barging into the bedroom--older couples have much less reason to be uptight about sex. They are also much more likely to be adept at pleasing each other, knowing where and how to arouse. Some sex counselors report that they see quite a bit of what anthropologist Margaret Mead called PMZ (post-menopausal zest). "Indeed, some women begin to have orgasms for the first time as they grow older," write Dr. Robert Butler and his wife, psychotherapist Myrna Lewis, in The New Love and Sex After 60 (Ballantine Books; 400 pages), the latest edition of their classic advice book.

So what's to fret about if you're only edging 60? Well, there are a few impediments. For all the cheerleading of sex-advice books and the fervor of magazines like Modern Maturity, the AARP's house organ (GREAT SEX: WHAT'S AGE GOT TO DO WITH IT? blared a cover a few years ago that featured a voluptuous Susan Sarandon), age does bring sexual changes for both genders. My father, who flirted outrageously even after he turned 90, liked to tell the story of the old guy who wants his doctor to "lower" his sex urge. At your age, says the astonished physician, you ought to be happy to have any sex urge. "You don't understand, Doc," the old guy persists. "I want you to lower it from here [pointing to his head] to there [his groin]." Erectile dysfunction is, in fact, no joke; it afflicts about 1 of every 4 men over age 45 and half of all men over 75.


| TIME | 19:26 | comments:0 | trackbacks:0 | TOP↑


You (and Your Brain) are What You Eat #2/2 ( By TIME - Jan. 08. 2006 )

I'm not aware of any brain foods that have as much scientific evidence behind them as fish and fish oil. But I would keep an eye on turmeric, the yellow spice that is a major ingredient in American mustard and Indian curries. A relative of ginger, turmeric comes from the underground stem of a tropical plant and is being carefully studied for its medicinal effects. It is a powerful anti-inflammatory agent that has anticancer properties and may offer significant protection against Alzheimer's disease. Alzheimer's begins as an inflammatory process in the brain. Anti-inflammatory agents like ibuprofen reduce the risk of Alzheimer's, and so do turmeric and its most studied component, curcumin. India has the world's lowest rate of Alzheimer's, and some experts think that daily consumption of turmeric is a contributing factor.

Finally, in addition to all the other reasons to eat fruits and vegetables, there are some that relate to the brain. The pigments that account for the varied colors of vegetables and fruits have antioxidant properties that offer significant protection against cancer and other chronic diseases, as well as protection from a range of environmental toxins, including pesticides. Toxic injury to the brain is almost certainly the cause of Parkinson's disease, and probably amyotrophic lateral sclerosis (Lou Gehrig's disease). For that reason alone, it's a good idea to eat every day from as many parts of the color spectrum as you can. It's also a good idea to take a daily multivitamin-multimineral supplement that provides the right doses and forms of the key antioxidants: vitamins C and E, mixed carotenoids and selenium.

A good diet is certainly not the only way to protect and enhance brain health. Regularly exercising the mind and not smoking are also important. But food choices do count. So eat your vegetables, think about your daily dose of omega-3s, and consider flavoring more of your food with turmeric.

Andrew Weil is clinical professor of medicine at the University of Arizona, where he founded the program in integrative medicine


| TIME | 19:35 | comments:0 | trackbacks:0 | TOP↑


You (and Your Brain) are What You Eat #1/2 ( By TIME - Jan. 08. 2006 )

We know that what you eat, and don't eat, can affect your health. But is it possible, as the White Rabbit advised Alice, to "feed your head"? Is there such a thing as brain food? I'm convinced there is. The evidence for some foods, such as fish, is stronger than for others, like turmeric and brightly colored vegetables. But none of those foods is bad for you, and they certainly won't make you any less smart.

The reason fish is so good for the brain is the so-called omega-3 fatty acids it contains. Oily fish, like salmon, sardines, mackerel, herring, bluefish and black cod, are the best sources of those special fats. One of the omega-3s―DHA―is the main constituent of cell membranes in the brain, and a deficiency of it can weaken the brain's architecture and leave it vulnerable to disease.

Diets associated with longevity and good health, like the Mediterranean and traditional Japanese diets, are high in omega-3 fatty acids from fish. The North American diet is not. I have long recommended that people in the U.S. eat more fish―at least two servings a week―but I have been concerned lately about reports of increasing levels of mercury, PCBS and other contaminants in certain fish species. In my diet I stick to sardines, herring, Alaskan black cod and Alaskan sockeye salmon. All sockeye (red) salmon are wild―fish farmers haven't yet been able to domesticate them―and since those fish are less carnivorous than other types of salmon, they have lower levels of the environmental contaminants that accumulate as you work your way up the food chain. Canned sockeye, available in most supermarkets, is a perfectly good source of omega-3s.

But for some people it may be easier and safer to rely on fish-oil supplements. The best are distilled and certified to be free of mercury and other toxins. Some are flavored, and some even taste good―or at least a lot better than the cod-liver oil I was forced to take as a kid. One product I recommend is Antarctic krill oil, made from the tiny crustaceans that abound in southern seas and are consumed in great quantities by whales and other marine mammals. Krill oil is red from carotenoid pigments, which have high antioxidant activity, and it doesn't cause those fishy burps. A good starting dose of fish oil of any kind is 1g a day. Higher doses, up to 10g a day, have been used, with varying results, to treat such diverse conditions as depression, attention deficit disorder, bipolar disorder and even autism.

Vegetarian sources of omega-3 fatty acids, such as walnuts, flax and hemp, are good additions to the diet but not so reliable as fish. They supply a short-chain compound (ALA) that the body must convert to long-chain DHA, and the efficiency of that conversion can vary. Some people don't do it well, and those eating mainstream diets top-heavy in the omega-6 fatty acids found in processed food and prepared meals are at a disadvantage because omega-6s interfere with the conversion of ALA to DHA. For vegetarians and vegans, there is one nonfish source of long-chain omega-3s: supplements made from algae. (Algae is the source of the omega-3s that fish store in their fat)


| TIME | 16:49 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #8/8 ( By TIME - Feb. 23. 2004 )

That may soon change. Researchers are looking beyond aspirin and other multipurpose medications to experimental drugs that block inflammation more precisely. Any day now, Genentech is expecting a decision from the FDA on its colon-cancer drug, Avastin, which targets one of the growth factors released by the body as inflammation gives way to healing. Millennium Pharmaceuticals is testing a different kind of drug, called Velcade, which has already been approved for treating multiple myeloma, against lung cancer and other malignancies. But there is a sense that much more basic research into the nature of inflammation needs to be done before scientists understand how best to limit the damage in chronic diseases.

In the meantime, there are things we all can do to dampen our inflammatory fires. Some of the advice may sound terribly familiar, but we have fresh reasons to follow through. Losing weight induces those fat cells--remember them?--to produce fewer cytokines. So does regular exercise, 30 minutes a day most days of the week. Flossing your teeth combats gum disease, another source of chronic inflammation. Fruits, vegetables and fish are full of substances that disable free radicals.

So if you want to stop inflammation, get off that couch, head to the green market and try not to stub your toe on the way.

--With reporting by Dan Cray/Los Angeles


| TIME | 07:26 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #7/8 ( By TIME - Feb. 23. 2004 )

No doctors have more experience treating chronic inflammation than the physicians who specialize in rheumatoid arthritis, multiple sclerosis, lupus and other autoimmune disorders. For decades these diseases have provided the clearest example of a body at war with itself. But the spark that fuels their internal destruction doesn't come from excess cholesterol deposits or a stubborn bacterial infection. Instead, in a bizarre twist of fate, the body's supersophisticated, learned immunological defenses mistakenly direct an inflammatory attack against healthy cells in such places as the joints, nerves and connective tissue.

Over the past few years, powerful drugs like Remicade and Enbrel, which target specific inflammatory cytokines, have worked wonders against rheumatoid arthritis and other autoimmune disorders. But as often happens in medicine, the drugs have also created some problems. Patients who take Remicade, for example, are slightly more likely to develop tuberculosis; the same inflammatory cytokines that attacked their joints, it seems, also protected them against TB.

Inflammation may be more of a problem in the earlier stages of autoimmune diseases like multiple sclerosis. So much tissue is eventually destroyed that nerve damage becomes permanent. "Your initial goal is to keep the immune response in check, but then you have to ask how you encourage regrowth of damaged tissue," says Dr. Stephen Reingold, vice president for research programs at the National Multiple Sclerosis Society. It could take decades to figure that one out.

    ... Continue to next


| TIME | 07:23 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #6/8 ( By TIME - Feb. 23. 2004 )

Over the past few years, researchers have shown that folks who take daily doses of aspirin--which is known to block COX2--are less likely to develop precancerous growths called polyps. The problem with aspirin, however, is that it can also cause internal bleeding. Then in 2000, researchers showed that Celebrex, another COX-2 inhibitor that is less likely than aspirin to cause bleeding, also reduces the number of polyps in the large intestine.

So, should you be taking Celebrex to prevent colon cancer? It's still too early to say. Clearly COX-2 is one of the factors in colon cancer. "But I don't think it's the exclusive answer," says Ray DuBois, director of cancer prevention at the Vanderbilt-Ingram Cancer Center in Nashville, Tenn. "There are a lot of other components that need to be explored."


When doctors treating Alzheimer's patients took a closer look at who seemed to be succumbing to the disease, they uncovered a tantalizing clue: those who were already taking anti-inflammatory drugs for arthritis or heart disease tended to develop the disorder later than those who weren't. Perhaps the immune system mistakenly saw the characteristic plaques and tangles that build up in the brains of Alzheimer's patients as damaged tissue that needed to be cleared out. If so, the ensuing inflammatory reaction was doing more harm than good. Blocking it with anti-inflammatories might limit, or at least delay, any damage to cognitive functions.

The most likely culprits this time around are the glial cells, whose job is to nourish and communicate with the neurons. Researchers have discovered that glial cells can also act a lot like the mast cells of the skin, producing inflammatory cytokines that call additional immune cells into action. "The glial cells are trying to return the brain to a normal state," explains Linda Van Eldik, a neurobiologist at Northwestern University Feinberg School of Medicine in Chicago. "But for some reason, in neurodegenerative diseases like Alzheimer's, the process seems to be out of control. You get chronic glial activation, which results in an inflammatory state."

It appears that some people are more sensitive to plaques and tangles than others. Perhaps they have a genetic predisposition. Or perhaps a long-running bacterial infection, like gum disease, keeps the internal fires burning and tips the balance toward chronic inflammation.

Preliminary research suggests that low-dose aspirin and fish-oil capsules--both of which are known to reduce inflammatory cytokines--seem to reduce a person's risk of Alzheimer's disease. Unfortunately, most of these preventive measures need to be started well before any neurological problems develop. "What we've learned with dementia is that it's very hard to improve people who already have it," says Dr. Ernst Schaefer, a professor of medicine and nutrition at Tuft's Friedman School of Nutrition in Boston. "But it may be possible to stabilize people and to prevent disease."

    ... Continue to next


| TIME | 07:20 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #5/8 ( By TIME - Feb. 23. 2004 )

What they have discovered is a complex interplay between inflammation, insulin and fat--either in the diet or in large folds under the skin. (Indeed, fat cells behave a lot like immune cells, spewing out inflammatory cytokines, particularly as you gain weight.) Where inflammation fits into this scenario--as either a cause or an effect--remains unclear. But the case for a central role is getting stronger. Dr. Steve Shoelson, a senior investigator at the Joslin Diabetes Center in Boston, has bred a strain of mice whose fat cells are supercharged inflammation factories. The mice become less efficient at using insulin and go on to develop diabetes. "We can reproduce the whole syndrome just by inciting inflammation," Shoelson says.

That suggests that a well-timed intervention in the inflammatory process might reverse some of the effects of diabetes. Some of the drugs that are already used to treat the disorder, like metformin, may work because they also dampen the inflammation response. In addition, preliminary research suggests that high CRP levels may indicate a greater risk of diabetes. But it's too early to say whether reducing CRP levels will actually keep diabetes at bay.


Back in the 1860s, renowned pathologist Rudolf Virchow speculated that cancerous tumors arise at the site of chronic inflammation. A century later, oncologists paid more attention to the role that various genetic mutations play in promoting abnormal growths that eventually become malignant. Now researchers are exploring the possibility that mutation and inflammation are mutually reinforcing processes that, left unchecked, can transform normal cells into potentially deadly tumors.

How might that happen? One of the most potent weapons produced by macrophages and other inflammatory cells are the so-called oxygen free radicals. These highly reactive molecules destroy just about anything that crosses their path--particularly DNA. A glancing blow that damages but doesn't destroy a cell could lead to a genetic mutation that allows it to keep on growing and dividing. The abnormal growth is still not a tumor, says Lisa Coussens, a cancer biologist at the Comprehensive Cancer Center at the University of California, San Francisco. But to the immune system, it looks very much like a wound that needs to be fixed. "When immune cells get called in, they bring growth factors and a whole slew of proteins that call other inflammatory cells," Coussens explains. "Those things come in and go 'heal, heal, heal.' But instead of healing, you're 'feeding, feeding, feeding.'"

Sometimes the reason for the initial inflammatory cycle is obvious--as with chronic heartburn, which continually bathes the lining of the esophagus with stomach acid, predisposing a person to esophageal cancer. Other times, it's less clear. Scientists are exploring the role of an enzyme called cyclo-oxygenase 2 (COX-2) in the development of colon cancer. COX-2 is yet another protein produced by the body during inflammation.

    ... Continue to next


| TIME | 07:18 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #4/8 ( By TIME - Feb. 23. 2004 )

To test his hunch, Ridker needed a simple blood test that could serve as a marker for chronic inflammation. He settled on Creactive protein (CRP), a molecule produced by the liver in response to an inflammatory signal. During an acute illness, like a severe bacterial infection, levels of CRP quickly shoot from less than 10 mg/L to 1,000 mg/L or more. But Ridker was more interested in the low levels of CRP--less than 10 mg/L--that he found in otherwise healthy people and that indicated only a slightly elevated inflammation level. Indeed, the difference between normal and elevated is so small that it must be measured by a specially designed assay called a high-sensitivity CRP test.

By 1997, Ridker and his colleagues at Brigham and Women's had shown that healthy middle-aged men with the highest CRP levels were three times as likely to suffer a heart attack in the next six years as were those with the lowest CRP levels. Eventually, inflammation experts determined that having a CRP reading of 3.0 mg/L or higher can triple your risk of heart disease. The danger seems even greater in women than in men. By contrast, folks with extremely low levels of CRP, less than 0.5 mg/L, rarely have heart attacks.

Physicians still don't know for sure how inflammation might cause a plaque to burst. But they have a theory. As the level of LDL cholesterol increases in the blood, they speculate, some of it seeps into the lining of the coronary arteries and gets stuck there. Macrophages, alerted to the presence of something that doesn't belong, come in and try to clean out the cholesterol. If, for whatever reason, the cytokine signals begin ramping up the inflammatory process instead of notching it down, the plaque becomes unstable. "This is not about replacing cholesterol as a risk factor," Ridker says. "Cholesterol deposits, high blood pressure, smoking--all contribute to the development of underlying plaques. What inflammation seems to contribute is the propensity of those plaques to rupture and cause a heart attack. If there is only inflammation but no underlying heart disease, then there is no problem."

At this point, cardiologists are still not ready to recommend that the general population be screened for inflammation levels. But there's a growing consensus that CRP should be measured in those with a moderately elevated risk of developing cardiovascular disease. At the very least, a high CRP level might tip the balance in favor of more aggressive therapy with treatments--such as aspirin and statins--that are already known to work.


Before Dr. Frederick Banting and his colleagues at the University of Toronto isolated insulin in the 1920s, doctors tried to treat diabetes with high doses of salicylates, a group of aspirin-like compounds. (They were desperate and also tried morphine and heroin.) Sure enough, the salicylate approach reduced sugar levels, but at a high price: side effects included a constant ringing in the ears, headaches and dizziness. Today's treatments for diabetes are much safer and generally work by replacing insulin, boosting its production or helping the body make more efficient use of the hormone. But researchers over the past few years have been re-examining the salicylate approach for new clues about how diabetes develops.

    ... Continue to next


| TIME | 07:17 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #3/8 ( By TIME - Feb. 23. 2004 )

To understand better what all the excitement is about, it helps to know a little about the basic immunological response, a cascade of events triggered whenever the body is subjected to trauma or injury. As soon as that splinter slices into your finger, for example, specialized sentinel cells prestationed throughout the body alert the immune system to the presence of any bacteria that might have come along for the ride. Some of those cells, called mast cells, release a chemical called histamine that makes nearby capillaries leaky. This allows small amounts of plasma to pour out, slowing down invading bacteria, and prepares the way for other faraway immune defenders to easily enter the fray. Meanwhile, another group of sentinels, called macrophages, begin an immediate counterattack and release more chemicals, called cytokines, which signal for reinforcements. Soon, wave after wave of immune cells flood the site, destroying pathogens and damaged tissue alike--there's no carrying the wounded off the battlefield in this war. (No wonder the ancient Romans likened inflammation to being on fire.)

Doctors call this generalized response to practically any kind of attack innate immunity. Even the bodies of animals as primitive as starfish defend themselves this way. But higher organisms have also developed a more precision-guided defense system that helps direct and intensify the innate response and creates specialized antibodies, custom-made to target specific kinds of bacteria or viruses. This so-called learned immunity is what enables drug companies to develop vaccines against diseases like smallpox and the flu. Working in tandem, the innate and learned immunological defenses fight pitched battles until all the invading germs are annihilated. In a final flurry of activity, a last wave of cytokines is released, the inflammatory process recedes, and healing begins.

Problems begin when, for one reason or another, the inflammatory process persists and becomes chronic; the final effects are varied and depend a lot on where in the body the runaway reaction takes hold. Among the first to recognize the broader implications were heart doctors who noticed that inflammation seems to play a key role in cardiovascular disease.


Not long ago, most doctors thought of heart attacks as primarily a plumbing problem. Over the years, fatty deposits would slowly build up on the insides of major coronary arteries until they grew so big that they cut off the supply of blood to a vital part of the heart. A complex molecule called LDL, the so-called bad cholesterol, provided the raw material for these deposits. Clearly anyone with high LDL levels was at greater risk of developing heart disease.

There's just one problem with that explanation: sometimes it's dead wrong. Indeed, half of all heart attacks occur in people with normal cholesterol levels. Not only that, as imaging techniques improved, doctors found, much to their surprise, that the most dangerous plaques weren't necessarily all that large. Something that hadn't yet been identified was causing those deposits to burst, triggering massive clots that cut off the coronary blood supply. In the 1990s, Ridker became convinced that some sort of inflammatory reaction was responsible for the bursting plaques, and he set about trying to prove it.

    ... Continue to next

| TIME | 07:00 | comments:0 | trackbacks:0 | TOP↑


The Fires Within #2/8 ( By TIME - Feb. 23. 2004 )

But now that we are living longer, those same inflammatory strategies are more likely to slip beyond our control. Making matters worse, it appears that many of the attributes of a Western lifestyle--such as a diet high in sugars and saturated fats, accompanied by little or no exercise--also make it easier for the body to become inflamed.

At least that's the theory. For now, most of the evidence is circumstantial. (A few researchers think chronic inflammation can in some cases be good for you.) But that hasn't stopped doctors from testing the anti-inflammatory drugs that are already on pharmacy shelves to see if they have any broader benefits. What they've found is encouraging:

--In 2000 researchers concluded that patients who take Celebrex, a prescription drug from Pfizer that was originally designed to treat inflammation in arthritis, are less likely to develop intestinal polyps--abnormal growths that can become cancerous. Now there are dozens of clinical trials of Celebrex, testing, among other things, whether the medication can also prevent breast cancer, delay memory loss or slow the progression of the devastating neurodegenerative disorder known as Lou Gehrig's disease.

--As cardiologists gain more experience prescribing cholesterol-lowering statins, they are discovering that the drugs are more effective at preventing heart attacks than anyone expected. It turns out that statins don't just lower cholesterol levels; they also reduce inflammation. Now statins are being tested for their anti-inflammatory effects on Alzheimer's disease and sickle-cell anemia.

--DeCode Genetics, an Icelandic biotech firm, announced last week that it is launching a pilot study to test whether an anti-inflammatory drug that was under development for use in treating asthma might work to prevent heart attacks.

--Of course the granddaddy of all anti-inflammatories is aspirin, and millions of Americans already take it to prevent heart attacks. But evidence is growing that it may also fight colon cancer and even Alzheimer's by reducing inflammation in the digestive tract and the brain.

This new view of inflammation is changing the way some scientists do medical research. "Virtually our entire R.-and-D. effort is [now] focused on inflammation and cancer," says Dr. Robert Tepper, president of research and development at Millennium Pharmaceuticals in Cambridge, Mass. In medical schools across the U.S., cardiologists, rheumatologists, oncologists, allergists and neurologists are all suddenly talking to one another--and they're discovering that they're looking at the same thing. The speed with which researchers are jumping on the inflammation bandwagon is breathtaking. Just a few years ago, "nobody was interested in this stuff," says Dr. Paul Ridker, a cardiologist at Brigham and Women's Hospital who has done some of the groundbreaking work in the area. "Now the whole field of inflammation research is about to explode."

    ... Continue to next

| TIME | 07:00 | comments:0 | trackbacks:0 | TOP↑

2008年05月 | ARCHIVE-SELECT | 2008年07月