Caduceus Newsletter:  Fall 2013.02, Week of August 26 


Image from the U.S. Department of Energy Genome Program web site:   http://genomics.energy.gov  

Dr. Stan Eisen, Director
Preprofessional Health Programs
Christian Brothers University

650 East Parkway South
Memphis, TN  38104

Home page:

Caduceus Newsletter Archives:


Have you ever wondered what a prey organism is thinking when it’s being pursued by a predator?




If you really want to know, please go to Marginalia. 


Table of Contents:


1.  Events coming up.  
2.  ===AAMC STAT===, News from the Association of American Medical Colleges, August 19, 2013 issue. 
3.  From Medscape.com --  Obesity’s Toll:  1 in 5 Deaths Linked to Excess Weight.  
4.  In a simulated driving performance test, analysis shows that a dual task (driving and text messaging) causes subjects to respond more slowly to the onset of braking lights and showed in impairments in forward and lateral control. 
5.  Mars Society Calls for Students Worldwide to Compete.  
6.  An excellent gap year experience, from HealthLeadsusa.org
7.  From Medscape:  Cocoa, Even with Few Flavonoids, Boosts Cognition.  (Seriously, did you expect anything less?)  

8.  Marginalia:  What a prey organism must be thinking when it is being pursued by a predator.   


1.  Events coming up.  

October 24, 2013, 12:45 to 1:45 p.m., in CW105.

·         Presentation regarding the University of Tennessee School of Health Sciences Pharm.D. program, by Dr. Angela Finerson, Director of Recruitment.

November 7, 2013, 10 a.m. to 2 p.m. in Sabbatini Lounge.

·         Annual Health Career Opportunities Fair, where representatives of regional clinical healthcare programs visit our campus to answer your questions.  The event is anchored by The University of Tennessee Health Science Center.  Other programs which have already committed include:

o    Union University School of Pharmacy

o    University of Memphis School of Public Health


2.  ===AAMC STAT===, News from the Association of American Medical Colleges, August 19, 2013 issue. 


News from the Association of American Medical Colleges

August 19, 2013

•    AAMC, FAH, AHA Request Reversal of CMS Policy on Grace Periods
     for Nonpayment of Premiums
•    Enrollment Opens for Diversity and Inclusion Certificate Program
•    New e-Book Chronicles Teaching and Learning Experiences
•    Macy Foundation Report Highlights Experiences of Newest U.S.
     Medical Schools
•    On the Move

AAMC, FAH, AHA Request Reversal of CMS Policy on Grace Periods for Nonpayment of Premiums

The AAMC, along with the Federation of American Hospitals (FAH) and the American Hospital Association (AHA), asked the Centers for Medicare and Medicaid Services (CMS) to restore the longer mandatory grace period for patients who do not pay premiums. In a joint letter to CMS, the organizations expressed a number of concerns with the final policy, which shortened to one month the Affordable Care Act (ACA) required three-month grace period after which qualified health plans (QHPs) can terminate insurance coverage for individuals due to nonpayment of premiums. The original ACA measure allowed for low-income individuals who qualified for advance payment of premium tax credits to catch up on premiums before coverage was terminated. The groups stated that allowing QHPs to pay for services only during the first 30 days is contrary to the statutory requirement and would expose patients and hospitals to significant liability.

Enrollment Opens for Diversity and Inclusion Certificate Program

Enrollment is now open for an intensive academic program specifically designed to develop the competencies leaders need to drive diversity as a core component of excellence in health care. The AAMC Healthcare Executive Diversity and Inclusion Certificate Program includes a curriculum that focuses on applied skills that will assist students in successfully implementing a diversity project at their home institution. The certificate program consists of six modules to be completed in-person and through distance learning over the course of six months, beginning Jan. 13, 2014. The deadline for applications is Nov. 15. For those interested in applying, there is a series of videos of alumni from the inaugural program responding to frequently asked questions currently available online.

New e-Book Chronicles Teaching and Learning Experiences

The new e-Book Ten Years of Teaching and Learning Moments includes brief, first-person vignettes of teachers, students, and patients as they learn about the science and the art of medicine. The e-Book commemorates the first 10 years of the “Teaching and Learning Moments” column in Academic Medicine and all essays published from 2002–11, as well as an editorial by former Editor-in-Chief Steven L. Kanter, M.D., and commentaries by Rita Charon, M.D., Ph.D., Maren Batalden, M.D., M.P.H., and Elizabeth Gaufberg, M.D., M.P.H. The e-Book is available to download to the iPad, Kindle, or Nook. Also available for free download are Academic Medicine’s first two e-Books: Professionalism in Medicine and Medical Education: Foundational Research and Key Writings, 1994–2010, and Flexner Centenary: 27 Articles About Abraham Flexner and His Legacy.

Macy Foundation Report Highlights Experiences of Newest U.S. Medical Schools

According to a new report by the Josiah Macy Jr. Foundation, some of the country’s newest medical schools found it difficult to establish affiliations with hospitals in order to provide adequate clinical training to students, a condition necessary to meet accreditation standards. The New and Developing Medical Schools, Motivating Factors, Major Challenges, Planning Strategies, Part 2, provides an update on the eight schools featured in the 2009 report and describes the circumstances that led to the development of seven additional schools. It also offers important lessons learned as the 15 institutions begin to enroll classes and implement academic programs. Fourteen of the schools will enroll their charter classes by September 2013 and the other in 2014. Four schools graduated their charter classes this year. In 2006, the AAMC called for a 30 percent increase in medical school enrollment to address the physician shortage. According to the Macy Foundation report, this offered a “rationale for not only expanding class size but also creating additional medical schools.”

On the Move

Jon Hayes, M.H.A., C.M.P.E., has been named chief executive officer of The Children’s Hospital at OU Medical Center, Oklahoma’s largest and most comprehensive pediatric hospital. He is succeeded by Charles L. Spicer, president and chief executive officer of OU Medical System. Hayes joined Children’s from The University of Oklahoma College of Medicine where he served in various leadership positions since 2001.

Selwyn M. Vickers, M.D., has been named senior vice president for medicine and dean of the University of Alabama at Birmingham School of Medicine and will start his new position later this year. He is currently the Jay Phillips Professor and Chair of the Department of Surgery at the University of Minnesota Medical School. Anupam Agarwal, M.D., who has been serving as interim vice president and dean since February, will return to his position as director of the Division of Nephrology and vice chair for research in the Department of Medicine.
Philip C. Bagnell, M.D., retired as dean of the East Tennessee State University James H. Quillen College of Medicine at the end of July, having served since 2006. Ken Olive, M.D., executive associate dean for academic and faculty affairs, has been named interim dean of medicine.


3.  From Medscape.com --  Obesity’s Toll:  1 in 5 Deaths Linked to Excess Weight.  



Obesity's Toll: 1 in 5 Deaths Linked to Excess Weight

Jenni Laidman

Aug 15, 2013

Obesity is associated with nearly 1 in 5 US deaths, according to a study published online August 15 in the American Journal of Public Health. The new data suggest obesity's toll on Americans is more than 3 times previous estimates.

In research that counters previous studies of the effect of obesity on American life spans, Ryan K. Masters, PhD, a Robert Wood Johnson Foundation Health and Society Scholar at Columbia University's Mailman School of Public Health in New York City, and colleagues report that overweight and obesity were associated with 18.2% of all deaths among adults from 1986 through 2006 in the United States. Previous estimates of the effect of obesity on mortality, published in Demography in 2009, established an obesity-related death rate of approximately 5%.

In the current study, obesity appears to have a particularly strong effect among black women, with 26.8% (95% confidence interval [CI], 7.3% - 47.4%) of deaths associated with a body mass index (BMI) of 25 kg/m2 or higher. In white women, 21.7% (95% CI, 14.4% - 29.3%) of deaths were associated with overweight or obesity. Among black men, 5.0% (95% CI, −6.8 - 18.3) of deaths were associated with overweight or obesity, and among white men, 15.6% (95% CI, 8.6 - 22.9) were.

The study also showed that the more recent the birth year, the greater effect obesity has on mortality rates. Further, contrary to claims in much public health literature, obesity is not protective for the elderly.

"Obesity has dramatically worse health consequences than some recent reports have led us to believe," Dr. Masters said in a university news release.

The authors write that prior estimates ignored various factors such as low participation in public health surveys by obese people. In addition, previous studies often relied on average obesity rates, even though such averages blur the substantial differences among various age groups.

Using data from 19 consecutive waves of the National Health Interview Survey covering 1986 through 2004, and linking those data with mortality information in the National Death Index through 2006, the researchers analyzed obesity and mortality among 290,383 white men, 41,710 black men, 324,131 white women, and 61,344 black women, all aged between 40 and 84.9 years.

The authors excluded people aged 85 years and older to avoid biases induced by the National Health Interview Survey coding of 85+ years. They also excluded the 1% of the sample with a BMI less than 18.5 kg/m2, which can be an indicator of illness, frailty, or mortality risk, according to the authors.

The investigators followed federal guidelines, setting normal BMI as 18.5 to 24.9, overweight as 25.0 to 29.9, and obese as 30.0 kg/m2 and higher. Further, obesity was stratified as grade 1 for a BMI between 30.0 and 34.9 kg/m2 and grade 2/3 for a BMI of 35.0 kg/m2 or higher.

Obesity-Associated Morality Growing

Grade 1 obesity accounted for an increasing number of deaths in each successive age group. For example, an analysis of population-attributable fractions (PAFs) showed that those born in the 1960s experienced higher obesity-related mortality than those born in the 1930s or 1920s. PAF is a calculation of the proportional reduction in mortality that would occur if the risk factor under consideration, such as obesity, were replaced with the ideal alternative, such as a normal-range BMI.

Among white men born from 1915 to 1919, 3.4% of all deaths at age 66 years could be attributed to grade 1 obesity. Men born just 10 years later saw obesity-related mortality rise to 4.5%, and for those born 10 years after that (ie, men born from 1935 to 1939), 5.8% of deaths at age 66 years were attributable to obesity. "These steady rises in PAF for class 1 obesity as a cause of adult mortality reflect more recent cohorts' greater exposure to obesity across their respective life courses," the authors write.

The data further reveal rising hazard ratios (HRs) for mortality and obesity as age increases. For instance, among white women, the HR for obesity at age 45 years is about 1.25, but by age 65 years, obesity increases the risk for mortality about 2-fold. Among black women, the HR for obesity at age 45 years is about 0.7, but by age 65 years, it rises to roughly 1.5.

"We believe that it is imperative for the US public and those who construct policy for that public to recognize that population health and more than a century of steady gains in life expectancy are being jeopardized by the obesity epidemic. Indeed, evidence has already implicated high rates of obesity as a significant contributor to the United States' relatively low life expectancy among high-income countries," the authors write.

The authors have disclosed no relevant financial relationships. The study was funded by the Robert Wood Johnson Foundation.

Am J Public Health. Published online August 15, 2013.


Medscape Medical News © 2013  WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this article: Obesity's Toll: 1 in 5 Deaths Linked to Excess Weight. Medscape. Aug 15, 2013.



4.  In a simulated driving performance test, analysis shows that a dual task (driving and text messaging) causes subjects to respond more slowly to the onset of braking lights and showed in impairments in forward and lateral control. 

Text Messaging During Simulated Driving (Frank A. Drews, Hina Yazdani, Celeste N. Godfrey, Joel M. Cooper, David L. Strayer )



Objective: This research aims to identify the impact of text messaging on simulated driving performance. Background: In the past decade, a number of on-road, epidemiological, and simulator-based studies reported the negative impact of talking on a cell phone on driving behavior. However, the impact of text messaging on simulated driving performance is still not fully understood. Method: Forty participants engaged in both a single task (driving) and a dual task (driving and text messaging) in a high-fidelity driving simulator. Results: Analysis of driving performance revealed that participants in the dual-task condition responded more slowly to the onset of braking lights and showed impairments in forward and lateral control compared with a driving-only condition. Moreover, text-messaging drivers were involved in more crashes than drivers not engaged in text messaging. Conclusion: Text messaging while driving has a negative impact on simulated driving performance. This negative impact appears to exceed the impact of conversing on a cell phone while driving. Application: The results increase our understanding of driver distraction and have potential implications for public safety and device development.


December 16, 200910.1177/0018720809353319 Human Factors: The Journal of the Human Factors and Ergonomics Societyvol. 51 no. 5 762-770.


From a website of the Passen Law Group of Chicago, http://www.passenlaw.com/blog/car-accident-law/texting-driving-epidemic :


distracted driving chart 300x224 Texting While Driving Epidemic


5.  Mars Society Calls for Students Worldwide to Compete.  


August 16, 2013

Mars Society Calls for Students Worldwide to Compete

by Suzanne Presto


The U.S.-based Mars Society called on university students around the world to help advance plans for a manned mission to the planet during the 16th Annual International Mars Society Convention in the U.S. state of Colorado.
It has been about six months since the non-profit Inspiration Mars Foundation, founded by space tourist and multi-millionaire Dennis Tito, proposed launching a manned mission toward Mars in five years. The plan calls for one man and one woman to fly within 160 kilometers of Mars and return to Earth.    

While the crew is slated to be American, the process of getting to Mars is an international endeavor.

The president of the Mars Society, Robert Zubrin, announced a competition that calls on teams of students around the world to design a two-person Mars flyby mission that could be launched in 2018.

Designs will be judged on their cost, quality, simplicity and ability to launch in five years. The U.S. space agency, NASA, the Mars Society and Inspiration Mars will choose the judges.

Zubrin said both the contest and a Mars flyby have the power to spur innovation.

"We need to mobilize the talent of the world in support of this mission," said Zubrin. "Inspiration Mars, in part, was set up to inspire people and show how the challenge of humans to Mars could inspire a new generation to want to develop their minds to become scientists, engineers, technological entrepreneurs and researchers."

A Mars Society press release says the design competition is open to university engineering students worldwide. While teams can include alumni, professors and others, the bulk of the teams must be made up of students. Finalists would present their ideas at NASA's Ames Research Center in California.

Zubrin notes that he is not part of Inspiration Mars, but he considers its mission to be "bold yet realistic," with enough resources to succeed.




6.  An excellent gap year experience, from HealthLeadsusa.org .   

The Role of College Students

Health Leads’ model is unique in leveraging college students to connect patients with the basic resources they need to be healthy. We mobilize students to serve as Health Leads Advocates by training them to deliver reliable, high-quality services for patients.

The URL for the home page -- https://healthleadsusa.org/get-involved/volunteer/

Here’s some information from the home page:

Volunteer with Health Leads

Passionate, self-aware, skilled and dedicated, the college students who volunteer as Health Leads Advocates are at the core of our program. They make Health Leads work.

What You Give

As a Health Leads Advocate, you’ll bring commitment, creativity, tenacity, and humility to your work with families.

And, as a member of the volunteer community on your campus, you will continuously reflect on your work with families and your own leadership development to make real change in healthcare.

Health Leads needs you! You can apply to work with us if you are a student at one of our partner universities. Health Leads Advocates:

Dedicate at least eight hours each week to Health Leads (the required number of hours is higher in some cities)

·         Commit to working with us for at least one school year

·         Participate in an initial kickoff training

·         As part of your eight hours, attend weekly reflection and follow-up sessions for continued training and professional development opportunities.

·         Join your fellow Advocates, faculty, clinic and community members for events and activities on campus

What You Get

As a Health Leads Advocate, you will learn about your community and the ways that different programs and resources impact poverty — and how they affect a person’s health.

You will be rigorously trained and coached to offer the best possible service to clients and our clinic communities.

It is an exciting time to be a part of healthcare in America. America is poised for a transformation in healthcare, and Health Leads is catalyzing change for better health.

We look forward to having you do it with us.

Apply to be a Health Leads Advocate

As an applicant, you will go through a rigorous and competitive application and interview process. Once you join us, you’ll receive extensive training before starting your work and real, meaningful support throughout your Health Leads experience.

If you are a student at one of our university partners and have an interest in poverty and health, you are eligible to apply to be a Health Leads Advocate. Click on a region below to read about their application process or contact the Health Leads office in your city.

·         Baltimore

·         Boston

·         Chicago

·         New York

·         Providence

·         Washington, DC



7.  From Medscape:  Cocoa, Even with Few Flavonoids, Boosts Cognition.  (Seriously, did you expect anything less?)  

Cocoa, Even With Few Flavonoids, Boosts Cognition

Pauline Anderson

Aug 08, 2013

Drinking cocoa, whether rich in flavonoids or not, appears to boost the effect of blood flow on neuronal activity in the brain, known as neurovascular coupling (NVC).

A new study shows not only that drinking flavonoid-rich or flavonoid-poor cocoa improves NVC but also that higher NVC is associated with better cognitive performance and greater cerebral white matter structural integrity in elderly patients with vascular risk factors.

As researchers search for ways to detect dementia at the earliest possible stage, the study results could pave the way for using NVC as a biomarker for vascular function in those at high risk for dementia, said lead author Farzaneh A. Sorond, MD, PhD, Department of Neurology, Stroke Division, Brigham and Women's Hospital, Boston, Massachusetts.

"Our study shows that NVC is modifiable and can be enhanced with cocoa consumption," said Dr. Sorond.

The study is published online August 7 in Neurology.

Tight Correlation

The double-blind proof-of-concept study included 60 community-dwelling participants, mean age 72.9 years. About 90% of the participants were hypertensive, but with well-controlled blood pressure, and half had diabetes mellitus type 2 with reasonably good control. Three quarters were overweight or obese.


Dr. Farzaneh A. Sorond

Participants were randomly assigned to 2 cups a day of cocoa rich in flavonoids (609 mg per serving) or cocoa with little flavonoids (13 mg per serving). Diets were adjusted to incorporate the cocoa, each cup of which contained 100 calories. Participants were also asked to abstain from eating chocolate.

Researchers measured cerebral blood flow in these participants using transcranial Doppler ultrasonography. Among other things, they documented changes in the middle cerebral artery and blood flow velocity at rest and in response to cognitive tasks (NVC).

The study showed that NVC was tightly correlated with cognition; scores for Trail making Test B, a test of executive function, were significantly better in those with intact NVC (89 seconds vs 167 seconds; P = .002). Participants with intact NVC also had significantly better performance on the 2-Back Task, a test for both attention and memory (82% vs 75%; P = .02).

"The higher you increase your blood flow during a cognitive task, the better your cognitive performance," commented Dr. Sorond, adding that this is something that has never been shown before.

NVC was also correlated with cerebral white matter structural integrity. Higher NVC was associated with overall less white matter macro- and micro-structural damage. In general, those with intact NVC had a greater volume of normal white matter and smaller volume of white matter hyperintensities, higher fractional anisotropy, and lower mean diffusivity in the normal white matter and WMH.

Therapeutic Target

These results suggest that NVC could be an important therapeutic target. But before NVC can be considered a biomarker, it has to be shown to be changeable, and the clinical importance of the modification must be shown.

To that end, the study authors opted to use cocoa. They could have chosen many other potential modifiers but chose cocoa because the literature has shown the beneficial effects of cocoa on brain health and also because it's something that many people enjoy, said Dr. Sorond.

The study found that blood pressure, blood flow, and change in NVC were not significantly different between the 2 cocoa groups. In the combined cocoa groups, 30-day blood pressures were not significantly different from baseline (P > .5).

In contrast, response to cocoa differed significantly depending on NVC status. Cocoa had a significant effect on NVC in those with impaired (<5%) coupling at baseline. Of those with impaired NVC, 89% responded to 30 days of cocoa consumption and increased NVC compared with only 36% of those with intact NVC (P = .0002). In those with impaired baseline coupling, cocoa consumption was associated with an 8.3% (P < .0001) increase in NVC at 30 days.

The effect of cocoa consumption on Trail B scores was also significantly dependent on NVC status.

The authors were surprised at the lack of effect of flavonoids because previous research had indicated a dose-response with respect to cognitive performance. It could be something other than flavonoids in the cocoa, possibly caffeine, that improves NVC, or it could be that the 13 mg in the low-flavonoid cocoa group was enough to have an effect.

"I think there are effects of flavonol on brain blood flow no matter how low it is," said Dr. Sorond, adding that perhaps only a tiny amount is needed to activate an enzyme or some other trigger.

It's important to identify the component or mechanism, whatever it is, because just telling patients to drink cocoa could be risky, said Dr. Sorond. "Patients with diabetes or hypertension really don't need the extra sugar, extra calories, and extra fat that come with it."

Dr. Sorond thinks NVC could be measured in high-risk patients seen in the clinic. "I think this could be an easy, in-clinic quick test of vascular brain function that pertains to cognitive performance."

The ideal next step would be to carry out a larger study in patients with mild cognitive impairment that includes more detailed cognitive profiles and more control groups. "We need a cocoa arm; we need a caffeine arm; we need maybe other arms, to make sure that we understand this, and maybe look at some of the metabolites in the blood as a result of cocoa consumption that correlates with these things," said Dr. Sorond.

Remarkable First Step

In an accompanying editorial, Paul B. Rosenberg, MD, associate professor of psychiatry and behavioral sciences, Johns Hopkins School of Medicine, Baltimore, Maryland, and Can Ozan Tan, PhD, Harvard Medical School, Boston, write that in many ways, the study represents a "remarkable first step."

For one thing, it demonstrates the practical utility of a simple, inexpensive, and noninvasive technique for measuring NVC that has several advantages over functional MRI and other means of measuring blood brain flow during cognitive tasks.

In demonstrating a link between NVC and cerebral white matter structural integrity, the study provides an important validation for the association between vascular and cognitive function, according to Dr. Rosenberg.

The study demonstrates that NVC "hangs together" as a measure of vascular function, which could be used in studies targeting vascular interventions, said Dr. Rosenberg in an interview with Medscape Medical News. In this way, he added, the study is "promising for the development of new treatments for vascular dementia."

The study suggests that the vascular effects of cocoa are not due to its flavonol content, noted Dr. Rosenberg."It could be a placebo effect."

Dr. Rosenberg pointed out several strengths of the study, including its relatively large size for a pilot study and its "well-chosen" measures.

Among its weaknesses are that it's not a placebo-controlled study and the hypothesis that flavonoid-rich cocoa would work better than flavonoid-poor cocoa didn't pan out. The study may also not have been long enough, said Dr. Rosenberg. "It's nice to see a drug work for 30 days, but you really need a longer study."

The study didn't include patients with mild cognitive impairment who are at risk of developing dementia, which Dr. Rosenberg sees as another weakness. "It's one thing to show an effect in cognitively healthy older people; it's a very different thing to show an effect in people who have a brain disease," he said.

The Alzheimer's Association also sees weaknesses in the study. Not only is it a very small and very preliminary study, but it was also not well designed as a test of an intervention or therapy because it didn't include a control group for comparison with the group that drank cocoa, said Maria Carrillo, PhD, Alzheimer's Association vice president of medical and scientific relations.

Further, said Dr. Carrillo, it didn't appear that other factors that could possibly affect brain blood flow and/or cognition were controlled for, tracked, or accounted for in the study.

"There is no information on what else the 18 people with impaired cerebral blood flow did during the trial that might have improved their cerebral blood flow or cognitive performance: exercise, for example. A well-designed intervention trial anticipates, tracks, and accounts for these possible confounding factors to help ensure the credibility of the findings."

Dr. Sorond has disclosed no relevant financial relationships. Dr. Rosenberg was supported by National Institute on Aging grants; has received research support from Merck, Lilly, Pfizer, and Functional Neuromodulation; and served as consultant to Jansen and Pfizer.

Neurology. Published online August 7, 2013. Abstract Editorial


Medscape Medical News © 2013  WebMD, LLC

Send comments and news tips to news@medscape.net.

Cite this article: Cocoa, Even With Few Flavonoids, Boosts Cognition. Medscape. Aug 08, 2013.



8.  Marginalia:  What a prey organism must be thinking when it is being pursued by a predator.   

Dr. Stan Eisen, Director
Preprofessional Health Programs
Biology Department
Christian Brothers University

650 East Parkway South
Memphis, TN 38104

E-mail: seisen@cbu.edu
Caduceus Newsletter Archives: http://www.cbu.edu/~seisen/Caduceus.html