Meddik

We’ve had a busy start to 2013 here at Meddik. In light of your great feedback and a fresh bout of new year’s energy, we’ve decided to start the year off with a product push. For us, this means long hours in front of our computers. For you, this means that during the next few weeks our blog will only be sporadically maintained. We hope this won’t be a great inconvenience. 

Thank you for your commitment to our goal to inspire collaborative health. Giddy with excitement over the new features we’re building for you, we look forward to having you join us again when the new and improved version of Meddik is unveiled. Feel free to contact us with any questions at feedback@meddik.com, and do keep checking the blog or subscribe for updates. 

Sincerely, 

The Meddik Team

If your grandma is anything like mine, “dieting” means cooking with four sticks of margarine instead of five. It means forgoing dinner rolls to make room for cheesecake, ordering pastrami on rye but nixing the chicken liver, and pouring sour cream over twice baked potatoes for a vegetarian dinner.

In the 1940s, when my grandmother ran the kitchen in her New York home, eating was sport. She and other New Yorkers fled to the Catskills on summer vacation, where they were fed three luxurious meals a day. Dieting was eschewed, mostly because scant meals conjured images of depressed economic times. Depression-era mothers took pride in preparing plentiful family dinners; they competed for the title of best chicken liver, and they revered the curvaceous figures of women like Marilyn Monroe.

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(Diners at Kutsher’s Resort in the Catskill Mountains of New York). 

Today, New York is no less pocketbook conscious, yet nearly everyone is trying to skim the fat off their diet. Weight loss has become a multi-billion dollar industry in the U.S. Inside of Manhattan and the boroughs, food subcultures have formed. What to eat or not eat has real social significance. There are gatherings for those who frown upon wheat. Online meetups have formed for modern day cavemen, who seek a return to the diet of their Paleolithic ancestors. A Google search for “diets that work” reveals an ever-changing list of newcomers. The DASH diet will help you lose weight and manage hypertension; the Alkaline diet will balance your pH levels; and the Ornish diet is a lifelong recipe for preventing coronary artery disease.

In the age of information, it’s no longer good enough for a weight loss plan to simply help us lose weight. Modern day eaters look to their diets for a lifestyle makeover. We want meal plans that dissolve wrinkles while making us more optimistic individuals. Will there some day be a diet that reduces mortgage payments? If you happen to come across it, please send us an email at feedback@meddik.com. For now, we’re ordering lunch on seamless. 

Holiday dinners may have ended, but we’ve still got food on the mind. We thought we’d close out the week by sharing the top 5 foods we’re vowing to not eat in 2013. Call them food unresolutions. Healthy though they may be, these five foods often offended our tastebuds and wallets in 2012. Rest assured, we’re striking them from our grocery list in 2013. 

#1 Sardines

Slimy, expensive fish in a can. Need we say more?

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#2 Sprouted Nuts 

The walnut variety sells for a whopping $16.99/pound at Whole Foods. What exactly is a sprouted nut anyway? We don’t understand, or care to understand, what all the hoopla’s about! We’re perfectly happy with our run o’ the mill walnuts from Trader Joe’s. 

#3 Capers 

Some foods stand the test of time. Some don’t. Capers: your time has come. We’ll miss your presence in our favorite Mediterranean dishes, but your bitter flavor has long outstayed its welcome. And we still haven’t forgiven you for the time you got stuck between our front teeth during a dinner date. 

#4 Soy Chicken

“Is this chicken, what I have, or is this fish?” Jessica Simpson once asked. “I know it’s tuna, but it says. ‘Chicken of the Sea’”. Well, Jessica, we feel the same way about soy chicken. It says chicken, but it’s not. Try as we might, we’ve yet to meet a slice of soy chicken we enjoyed eating. In 2013, we’re sticking with tofu and calling it a year.

#5 Kale 

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You were more popular than Kate Upton in 2012. But, truth be told, you require more accessorizing than Kate Upton to be palatable. You need to be dressed and washed and sautéed and flavored – and gosh darnit, we’re tired. All this tastelessness just isn’t worth its sticker price. We hate to break the news like this, Kale, but you’re high maintenance. We’re taking back the keys. Really, it’s over. We’re shopping in the spinach aisle. 

Fear is not a word we typically associate with a 6-foot-8 forward, weighing 270 pounds and boasting the widest hands – 11.5 inches (29.2 cm) – of any player in the NBA. But fear is what forced Royce White and his grandfather to drive cross-country for his college basketball games, when White was a player with Iowa State. And fear is what currently keeps Royce from playing basketball with his fellow teammates of the Houston Rockets.

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Royce White was the No. 16 draft pick for the NBA. He hasn’t played with the Rockets since November 12, due to his dispute over the Rockets’ handling of his anxiety. White suffers from generalized anxiety and a specific fear of flying. He’s requested travel accommodations, as well as comprehensive therapy and greater leniency during practices, to help him return to the sport safely. Media channels have falsely narrowed White’s story to a refusal to travel. But his day-to-day battle with anxiety is a 24-hour rollercoaster ride: it occurs both on and off the court, when preparing for a game, when running sprints, or when recalling moments from his childhood:

"I’m never at 100 percent because my anxiety is going to take me down 25 percent before the game starts," White says. "Before the game, I’m still feeling sick to my stomach because I want us to win so bad that my adrenaline is getting going before the game even starts. It’s hard to do it in front of 20,000 people. But I’ve trained my mind to deal with it."

What makes White’s case unique, is that he’s been both outspoken and unapologetic about his anxiety. On Twitter, he calls his request for accommodations a “right” to have safe work conditions: “Asking for safe work conditions is a right, not a complaint!” He’s also started the hashtag #AnxietyTroopers to reference the universal battle that afflicts 18% of the U.S. population each year. 

If White and The Rockets reach an agreement, White’s story will be aspirational: it will validate and uplift those whose apprehensions – both clinical and non – have placed them on the sidelines of their career. White is not the first NBA player to suffer from anxiety, but he’s the first to make a big stink about it — and for that, we’re cheering him on. 

We’re entering a new year, ripe with possibility. In honor of all that 2013 holds and promises to hold, we’ve assembled a guide to living more purposefully in the coming year.  

Without further ado, the Meddik Guide to Happiness in 2013: 

imageStep 1. Read What Challenges You

Take out a subscription – yes, a full magazine subscription – to a publication whose politics you don’t share. Let your mind roam free and you may be surprised by what you learn, even what you agree with. If you’re the novel reading type, try something outside your comfort zone. Replace science fiction with a romance novel. 

Step 2. Make A Date With Strangers

We often say that meeting new people is one of the joys of living. Yet awkward silence with a stranger while riding the elevator is the norm. Make a coffee or lunch date with a stranger in 2013. If you need a little inspiration, just watch this video.

Step 3. If You Hate the Thought of Snow, Start Skiing image

I have a friend with a strong distaste for snow. To be more accurate, he hates winter altogether, and its various “accouterments”, such as skiing. As with our advice on reading, the best way to expand your horizons is to try something that discomforts you. If this means getting on a pair of skiis for the very first time, take a deep breath and get out there.

Step 4. Appreciate Other Languages

Learning a new language has made many a new year’s resolution list, only to be forgotten weeks after January 1. Instead of promising proficiency, take in a language through more artful mediums, such as film, music or theatre.

Step 5. Seek Feedback or “Speed-back”

Most change happens in small increments. But you have to be in a growth mindset to appreciate change as it occurs. The V.P. of People Development at Google, Karen May, suggests trying something called “speed-back”. It works by placing people in fast-paced exercises and asking them to give feedback to each other, spur of the moment, based on their experience during an activity. For some, it is the best feedback – err, speed-back – they’ve ever received.

Step 6. Thank Someone Each Day

A rabbi I spoke with in September, during the Jewish New Year, advised me to say thank you more often. He said that “thank you” are the two most important words people can express to one another. “I love you” and “I’m sorry” are also good, but too often they’re overused. There is always something to be thankful for, and always someone whom is deserving of thanks. Seek out those people, and the opportunity to thank them.

Step 7. Rearrange Your Workspace Periodically

We tried this tactic at Meddik, and it livened our office with renewed vigor. Rearranging your workspace imbues the mind with creative energy. If you have not much space or furniture to rearrange, try adding a new piece of décor, refreshing flowers, or adding new desk pictures.

Step 8. Plan a Trip image

You need not go far. (Truth be told, not everyone can afford an exotic vacation to Thailand). But if you save a little each week (Step 9), you can plan something meaningful for yourself. In making your itinerary, we suggest leaving time to enjoy each site you see (i.e., don’t over-book), and including adventurous day trips.  

Step 9. Save for Something

Travel always tops our list, but saving for smaller budget items is a great way to reward yourself. The act of saving is an accomplishment in and of itself – so treat it as such. Make a ritual of adding to your savings account. Be thoughtful about how the money will benefit you in the future.

Step 10. 10@10

At Meddik, we refer to our morning meetings as 10@10. Ten minutes of work updates and conversation, punctuated by lively debate. This 10@10 should be reserved for the evening hours – and can be replaced with 10@11 or 10@12 if that suits you better. Take 10 minutes to reflect on your day. Record your thoughts, whether on paper or electronically, which adds a second layer of processing to the exercise. Then, put your thoughts away, allow your mind to relax, and enjoy a restful night’s sleep. 

Ted Kaptchuk, an Associate Professor of Medicine at Harvard, is encouraging scientists to investigate the healing power of placebos. He believes that researchers have narrowly studied medications for years, struggling to bolster their effects, while few have attempted to increase the effect of placebos.

But why on earth would a medical researcher bet on the strength of a sugar pill, over years of hard fought scientific data on drug treatment?

Kaptchuk’s ideas first gain traction in the early 2000s in a study of patients with irritable bowel syndrome (IBS). It was one of the earliest trials to not only examine the placebo effect, but also compare a dose-dependent response. In other words, Kaptchuk was curious to see if patients showed different rates of improvement in response to two types of placebos. His hypothesis was correct: patients who received sham acupuncture for IBS, combined with extensive physician care (Placebo Group 3), responded better than patients who received sham acupuncture combined with limited physician care (Placebo Group 2). The amount of care received was directly correlated with improvement. Ten years later, in December 2010, Kaptchuk conducted a similar study, also in IBS patients, only this time he informed patients that they were going to receive placebo. The effect was the same: patients in the placebo group scored an average of 5.0 on a scale measuring global improvement, while patients in the no pill group (the control condition) scored a 3.9.

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The placebo effect has been observed in medication trials for decades. It’s believed to result from actual neurochemical changes in the brain caused by the belief that medications make people feel better. A growing number of doctors are catching “placebo fever” – though an equal number of naysayers walk among them – and research institutions are throwing up laboratories wholly devoted to their study. At Harvard’s Program in Placebo Studies, doctors are using sham procedures – yes, fake surgeries – to fight disease and chronic pain. The bigger the treatment, the bigger the placebo effect, said one Harvard researcher on 60 minutes this past Sunday. But because the placebo effect bets on our expectations of how medications work, it relies on a heavy dosage of deception. Moreover, it could have no effect at all for patients who question the efficacy of medication to begin with. Teasing out who is most likely to respond, and what other conditions are required for that response, will require several, if not hundreds, of sham drug trials. Could patients be swayed by the power of nothing? We’ll just have to wait and see.   

While residents of a bereaved Connecticut town face a new week, Americans across the country are grappling with the question of why horrific tragedies like Newtown occur in the first place. It’s a question that burns in our minds, as we mourn the loss of 26 lives, most of them children ages 6 and 7.  

We can cite lax gun control laws as the reason mass murderers are given access to guns. But this does not explain the intent to kill, especially in a young teenager with no history of violent behavior. Unless we ban the sale of semi-automatic weapons altogether – an unlikely change for a country that espouses its right to bear arms – improved gun control would not prevent a shooting spree in which Adam Lanza used his mother’s legally registered weapons. The Justice Department has proposed enforcing stricter regulations on the sale of guns, including background checks to identify the mentally ill, but even this would not stop an individual without a history of treatment. If there is no paper trail documenting a troubled past, the Justice Department is inept. “Meaningful action” – President Obama’s not so subtle reference to gun control – is needed to prevent these tragedies from occurring. But it would be more meaningful to talk about what’s happening to our nation’s teenagers before they acquire a gun. 

Newtown was the second mostly deadly mass murder on American soil. It bears the hallmark characteristics of all the school shooting sprees that have preceded it. The table below, compiled by staff at the New York Times [the age column at right is our own addition], describes the 11 most deadly shootings in American history. A few patterns are worth noticing: 1) 6 of the 12 gunmen were age 25 and younger; 2) all of the shooting sprees in that subset took place within a school environment, except Aurora, Colorado; 3) 5 of the 6 gunmen committed their acts within the last 13 years; 4) 6 of the 6 gunmen were white males; 5) 6 of the 6 gunmen had an untreated psychological illness. And let’s not forget the other examples: Thurston High School in 1998 (gunman Kipland Kinkel, Age 15; 29 killed and injured); Lake Senior High School in 2005 (gunman Jeffrey Weise, Age 16; 16 killed and injured).

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If we learn anything from Newtown and its sister tragedies, it’s that meaningful action must occur before the point of purchase, or the illegal acquisition of a gun. We cannot turn a blind eye when children with mental illness slip under the radar. Gun control will reduce the presence of weapons, but it will also put a band-aid on a systemic health problem that festers among us. When asked about the motive behind the Newtown shooting, Marsha Lanza, aunt of Adam Lanza, was at a loss for an explanation: “I wish I had an answer for you,” she said, “I wish somebody had saw it coming.” After Newtown, we all need to talk about what we can do to see it coming, and prevent it. 

There are a host of prescription medications designed for pain management, but whether these medications provide relief is entirely dependent on individual response. In a 2007 town hall meeting, Mitt Romney said that he would not support the legalization of marijuana for medicinal purposes because “pain management is available from other sources”. Perhaps Romney never met six-year-old, Jayden David, a boy who suffers from violent seizures, and for whom bathing, eating and walking was an ordeal, until he began taking a liquid, nonpsychoactive form of marijuana.

(Select the image below to hear Jayden’s story.)                  image

Pharmacotherapy has always been a process of trial and error. Minocycline, a commonly prescribed antibiotic, works like a cure-all drug for some patients, yet it’s no better than a sugar pill for others. Drugs used to retard cancer development are notoriously fickle, rapidly attacking cancerous cells for a period, and then, like a switch suddenly turned off, they stop working. If we accept as fact that, on the whole, medical marijuana is effective for pain management, with side effects no more dangerous than other analgesics, the question becomes not one of comparative treatment (e.g., is marijuana better than morphine?) but rather, who is most likely to benefit from medical cannabis? What is the clinical history of that patient?

For patients with an incurable condition, there is a personalized, concierge aspect to treatment that explains why some experience symptom reduction and some do not. Opponents of medical marijuana will argue that it’s under-researched, and that treatment from a young age puts children at risk for complications later in life. Though more studies are certainly welcome, we should remember that the risk-benefit ratio for patients like Jayden is fundamentally different than in the general population. For Jayden, medical marijuana is a life-giving drug. 

For every identified Celiac patient (a person whose body cannot tolerate gluten, causing damage to the small intestine), there are 3-10 patients who have clinical histories consistent with Celiac Disease, but who fail to meet diagnostic criteria. Patients with non-celiac, gluten sensitivity (NCGS) can suffer for 10 or more years without a diagnosis. Because they cannot meet the basic “requirements” of the illness, their condition does not register on a doctor’s radar: it’s not present in lab tests, it’s not indicated in their family history. In a November issue of the British Medical Journal, a patient chronicles his struggle with NCGS.    image

Strangely enough, at a time when Celiac Disease awareness is increasing, underdiagnosis remains a problem. It raises an awkward question: Do physicians discount patient experience when it cannot be aligned with medical text? Moreover, what does it take for the cultural tides of an illness – how it’s described, how it’s diagnosed, how it’s treated – to change?

For centuries, the formulation of disease has been shaped by medical zeitgeist. Autism is currently understood to carry a strong genetic loading, but in the 1950s, that genetic link was viewed through an environmental lens – one of maternal deprivation – and so-called “refrigerator mothers” were blamed for raising autistic children.

In Celiac Disease, flare-ups indicative of gluten intolerance despite negative blood tests and biopsies, may be enough to frustrate and delude doctors. As one gastroenterologist put it, the underdiagnosis of Celiac Disease is led by an “irrational resistance” in the medical community to a widespread recommendation for gluten avoidance. Physicians acknowledge that many patients respond favorably to a gluten-free diet, even when they maintain that those who fail to meet diagnostic criteria should not be regulated to gluten-free eating.

Anecdotal evidence from patients – the kind that some gastroenetrologists are skeptical of – can lead to false conclusions about causation. As a general rule, the medical community only applies so much weight to case studies like the one in BMJ; these rarely form the basis for large-scale clinical trials. Nonetheless, the formulation of disease should include space for patient observation. As the culture of a disease evolves, we should remember that patient experience fits into a broader, more complex picture of illness.  

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You wake up with excruciating shoulder pain and call your physician’s office. He prescribes a 30-day supply of the painkiller, codeine. The pain persists on a low dose, so he increases the strength to 30mg. But on a higher dosage, you experience terrible nausea and dizziness. Five prescriptions and 150 unused pills later, you’re still searching for a panacea. Are the unused pills safe in your medicine cabinet? Can they be tossed in the trash? Who’s responsible if they fall into the wrong hands?   

Once a drug leaves the secure confines of a pharmacy, the burden of proper storage and disposal rests squarely on the shoulders of patients. Rates of prescription drug abuse are staggering, with nearly all drug poisonings resulting from an improperly used medication. Among teens, drugs are easily passed from patient to patient, a phenomenon that sustains the widespread abuse of ADHD medications in secondary schools. Of the 71,000 youth seen in the ER for a drug overdose each year, nearly half report that the abused substance was not their own to begin with: some pocketed it from a parent’s medicine cabinet, while a substantial number cannot trace its exact origins.

The rule of individual responsibility for drug disposal is faltering. California has taken notice. The state is now asking pharmaceutical companies to implement drug take-back programs, which would allow consumers to properly dispose of unused medications at a collection site. It’s a step in the right direction – if the legality of the proposal can be upheld against challenges from PhRMA. But drug return programs are only the tip of the iceberg. Physicians, pharmacists and public health officials must provide didactics on proper disposal, and teach patients that hoarding is not an innocuous practice. I cannot recall the last time I left a clinic or a pharmacy with specific instructions on how to dispose of my unused pills. Surely drug manuals – all 20,000+ words printed in 6 point font – must contain useful details on disposal. But then again, I typically toss the drug manual in the trash, along with my unused pills. 

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