America does a mediocre job caring for its sickest people.  The nation, says a new report, gets a C.

Palliative care programs make patients facing serious and chronic illness more comfortable by alleviating their pain and symptoms and counseling patients and their families.

Only Vermont, Montana and New Hampshire earned an A, according to America’s Care of Serious Illness: A State-by-State Report Card on Access to Palliative Care in Our Nation’s Hospitals, a report based on a study in the October 2008 issue of the Journal of Palliative Medicine.  Three states – Oklahoma, Alabama and Mississippi – got an F.

“The good news is that hospitals nationwide have implemented palliative care programs quickly over the last six years,” said R. Sean Morrison, MD, director of the non-profit National Palliative Care Research Center and senior author of the study.  “The bad news is that if you live in the South or you have to rely on public or small community hospitals, you’re in trouble.”

Ninety million Americans are living with serious illnesses such as cancer, heart disease, diabetes, Parkinson’s, stroke and Alzheimer’s.  As the baby boomers age, this number will more than double over the next 25 years.

“Americans are living longer – but with serious illnesses,” said Dr. Diane E. Meier, director of the Center to Advance Palliative Care and co-author of the study.  “Without palliative care, people with serious illnesses like cancer often suffer unnecessarily from severe fatigue, pain, shortness of breath, nausea and other symptoms from their disease and treatments.”

The study suggests that in states with more palliative care programs, patients are less likely to die in the hospital; don’t have to go to the intensive care unit as much in the last six months of life; and spend fewer days in intensive care or the coronary unit in the last six months.

That also saves hospitals money, which could help lower health care costs.

When dining at Chinese Buffets, overweight individuals serve themselves and eat differently than normal weight individuals.  This may lead them to overeat, according to a recent study by Cornell University’s Food and Brand Lab.  Compared to normal weight diners, overweight individuals sat 16 feet closer to the buffet, faced the food, used larger plates, ate with forks instead of chopsticks, and served themselves immediately instead of browsing the buffet.

“What’s crazy is that these people are generally unaware of what they’re doing – they’re unaware of sitting closer, facing the food, chewing less, and so on,” say Brian Wanink, lead author of this study and of the book “Mindless Eating: Why We Eat More Than We Think.”

The study was published in the journal Obesity and includes observations of 213 diners at 11 all-you-can-eat Chinese restaurant buffets across the country.  Study participants included a range of normal weight to obese diners, none of whom were Asian.  Major study findings include:

* 27% of normal-weight patrons faced the buffet compared to 42% of obese diners.

* Overweight diners sat an average of 16 feet closer than normal-weight diners.

* 16% of obese diners sat at a booth rather than a table compared to 38% of normal weight diners

* 71% of normal-weight diners browsed the buffet before serving themselves compared to 33% of obese diners

* 24% of normal-weight people used chopsticks compared with 9% of overweight people

“When food is more convenient people tend to eat more,” say coauthor Collin R. Payne, New Mexico State University.

“These seemingly subtle differences in behavior and environment may cause people to overeat without even realizing it.”

An overload of calories throws critical portions of the brain out of whack, reveals a study in the October 3rd issue of the journal Cell, a Cell Press publication.  That response in the brain’s hypothalamus—the “headquarters” for maintaining energy balance—can happen even in the absence of any weight gain, according to the new studies in mice.

The brain response involves a molecular player, called IKKß/NF-?B, which is known to drive metabolic inflammation in other body tissues.  The discovery suggests that treatments designed to block this pathway in the brain might fight the ever-increasing spread of obesity and related diseases, including diabetes and heart disease.

“This pathway is usually present but inactive in the brain,” said Dongsheng Cai of the University of Wisconsin-Madison.  Cai said he isn’t sure exactly why IKKß/NF-?B is there and ready to spring into action in the brain.  He speculates it may have been an important element for innate immunity, the body’s first line of defense against pathogenic invaders, at some time in the distant past.

” In today’s society, this pathway is mobilized by a different environmental challenge—overnutrition,” he said.  Once activated, “the pathway leads to a number of dysfunctions, including resistance to insulin and leptin,” both important metabolic hormones.

Earlier studies showed that overnutrition can spark inflammatory responses in the peripheral metabolic tissues, including the muscles and liver, and therefore cause various metabolic defects in those tissues that underlie type 2 diabetes.  As a result, scientists identified IKKß as a target for an anti-inflammatory therapy that was effective against obesity-associated diabetes.

Yet whether metabolic inflammation and its mediators played a role in the central nervous system remained uncertain.  Now, the researchers show that a chronic high-fat diet doubles the activity of this inflammatory pathway in the brains of mice.  Its activity is also much higher in the brains of mice who are genetically predisposed to obesity, they found.

The researchers report that that increased activity of the IKKß/NF-?B pathway can be divorced from obesity itself -infusions of either glucose or fat into the brains of mice alone led to this inflammatory brain reaction.

Further studies revealed that this activity in the brain leads to insulin and leptin resistance.  Insulin lowers blood sugar by causing cells of the body to take it up from the bloodstream.  Leptin is a fat hormone important for appetite control.

Moreover, the researchers found that treatments preventing the activity of IKKß/NF-?B in the animals’ brains protected them from obesity.

While chronic inflammation is generally considered a consequence of obesity, the new results suggest the inflammatory reaction might also be a cause of the imbalance that leads to obesity and associated diseases, including diabetes.  As Cai says, it appears that inflammation and obesity are “quite intertwined.”  An abundance of calories itself promotes inflammation, while obesity also feeds back to the neurons to further promote inflammation in a kind of vicious cycle.

The findings could lead to treatments that might stop this cycle before it gets started.

“Our work marks an initial attempt to study whether inhibiting an innate immune pathway in the hypothalamus could help to calibrate the set point of nutritional balance and therefore aid in counteracting energy imbalance and diseases induced by overnutrition,” the researchers said.  “We recognize that the significance of this strategy has yet to be realized in clinical practice; currently, most anti-inflammatory therapies have limited direct effects on IKKß/NF-?B and limited capacity to be concentrated in the central nervous system.  Nonetheless, our discoveries offer potential for treating these serious diseases.”

If realized, such a strategy would likely offer a safe approach given that the critical pathway appears to be unnecessary in the hypothalamus under normal circumstances, they noted.

A carefully framed combination of moderate exercise and nutritional supplements could help older people maintain an active lifestyle for longer.

A Manchester Metropolitan University study has found that taking carbohydrate and protein supplements just before and just after low-resistance exercise could boost muscle performance and slow muscle wastage in people over retirement age.

Moreover, this combination appears to deliver greater fitness benefits than undertaking heavy-resistance training with or without changing one’s nutritional habits.

This was the first-ever study of the combination of structured exercise and nutritional supplements to focus wholly on older people.  Undertaken as part of the SPARC (Strategic Promotion of Ageing Research Capacity) initiative, the findings will be discussed at this year’s BA Festival of Science in Liverpool on Thursday 11th September.  SPARC is supported by the Engineering and Physical Sciences Research Council (EPSRC) and the Biotechnology and Biological Sciences Research Council (BBSRC).

This groundbreaking study involved a carefully selected sample of around 60 healthy, independent-living adults aged 65 and over.

The volunteers were randomly divided into groups who underwent different 12 week programmes of physical exercise and nutritional supplementation.  Everyone was then re-assessed at the end of the programme.

Some groups undertook low-resistance exercise once a week; others undertook high-resistance exercise twice a week.  Within each group, some of the volunteers took protein and carbohydrate supplements while others did not.

When all the participants were re-assessed at the end of the 12 week programme, it was observed that muscle size and strength had increased in all groups.

However, the results suggested that older people would derive the most benefits if they took appropriate supplements coupled with low-intensity exercise.

“Maintaining muscle performance and arresting muscle wastage can offer older people real improvements in their quality of life,” says Dr Gladys Pearson, who led the research.  “Though we still need to assess precisely what level of exercise gives the best results, we believe we’ve shown that regular low-resistance exercise complemented by the right nutritional supplements could boost the well-being of the UK’s ageing population.”

Dr Pearson and her team now aim to look at the effectiveness of novel combinations of strength training and nutritional supplementation as a way of speeding recovery and improving mobility for old and young orthopaedic surgery patients.

Individuals who have a genetic mutation associated with high body mass index (BMI) may be able to offset their increased risk for obesity through physical activity, according to a report in the September 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

There is a widely acknowledged genetic component to BMI and obesity, according to background information in the article.  Recently, a strong association has been shown between BMI and variants of one gene, known as the fat mass and obesity associated (FTO) gene.  The mutations associated with obesity are present in about 30 percent of European populations and are associated with a 1.75-kilogram (about 3.9 pounds) increase in body weight.  Lifestyle factors such as diet and physical activity are also important contributors to weight gain, but it is unknown exactly how they interact with genetics.

Evadnie Rampersaud, M.S.P.H., Ph.D., then of the University of Maryland School of Medicine in Baltimore and now of the University of Miami, and colleagues analyzed DNA samples of 704 healthy Amish adults (average age 43.6, 53 percent men and 47 percent women) recruited from 2003 to 2007.  Participants also underwent a series of physiological tests, including a seven-day measurement of physical activity using an instrument known as an accelerometer.

A total of 54 percent of the men and 63.7 percent of the women were overweight, and 10.1 percent of the men and 30.5 percent of the women were obese.  In the genetic analysis, 26 single-nucleotide polymorphisms (SNPs, or changes in a single base letter of DNA) in the FTO gene were associated with BMI.

The researchers then divided participants into two groups based on their physical activity levels and assessed the relationship between BMI and the two strongest SNPs.  Both SNPs were associated with BMI only in individuals who had low physical activity scores for their age and sex; they had no effect on those with above-average physical activity scores.

“Activity levels in the ‘high-activity’ stratum were approximately 900 calories [860 calories for women and 980 calories for men] higher than in the ‘low-activity’ stratum, which, depending on body size, corresponds to about three to four hours of moderately intensive physical activity, such as brisk walking, house cleaning or gardening,” the authors write.

“In conclusion, we have replicated the associations of common SNPs in the FTO gene with increased BMI and risk to obesity in the Old Order Amish,” they conclude.  “Furthermore, we provide quantitative data to show that the weight increase resulting from the presence of these SNPs is much smaller and not statistically significant in subjects who are very physically active.  This finding offers some clues to the mechanism by which FTO influences changes in BMI and may have important implications in targeting personalized lifestyle recommendations to prevent obesity in genetically susceptible individuals.”

Common genetic variations affecting nicotine receptors in the nervous system can significantly increase the chance that European Americans who begin smoking by age 17 will struggle with life-long nicotine addiction.  Published July 11 in the open-access journal PloS Genetics, this research – led by scientists at the University of Utah together with colleagues from the University of Wisconsin – highlights the importance of preventing early exposure to tobacco through public health policies.

These common genetic variations, or single nucleotide polymorphisms (SNPs), are changes in a single unit of DNA.  A haplotype is a set of SNPs that are statistically linked.  The researchers found that one haplotype for the nicotine receptor put European American smokers at a greater risk of heavy nicotine dependence as adults, but only if they began daily smoking before the age of 17.  A second haplotype actually reduced the risk of adult heavy nicotine dependence for people who began smoking in their youth.

The researchers studied 2,827 long-term European American smokers, recruited in Utah and Wisconsin, and to the National Heart, Lung, and Blood Institute’s Lung Health Study.  They assessed the level of nicotine dependence for all smokers, recording the age they began smoking daily, the number of years they smoked, and the average number of cigarettes smoked per day.  DNA samples were taken from all smokers, and the researchers recorded the occurrence of common SNPs, grouped into four haplotypes, which had been identified earlier in a subset of participants.

They found that people who began smoking before the age of 17 and possessed two copies of the high-risk haplotype had from a 1.6-fold to almost 5-fold increase in risk of heavy smoking as an adult.  For people who began smoking at age 17 or older, presence of the high-risk haplotype did not significantly influence their risk of later addiction.

Although the authors caution that different haplotype frequencies would likely be observed in different ethnic populations, Robert Weiss, Ph.D., professor of human genetics at the University of Utah and lead author of the study, explains: “We know that people who begin smoking at a young age are more likely to face severe nicotine dependence later in life.  This finding suggests that genetic influences expressed during adolescence contribute to the risk of lifetime addiction severity produced from the early onset of tobacco use.”

“This study adds to recent advances in understanding how genetic variation can affect susceptibility to nicotine addiction, success or failure of smoking cessation treatments, and the risk of disease associated with tobacco use,” says National Institute on Drug Abuse (NIDA) Director Dr. Nora Volkow.  “As we learn more about how both genes and environment play a role in smoking, we will be able to better tailor both prevention and cessation programs to individuals.”  The study was funded in part by NIDA and the National Heart, Lung, and Blood Institute (NHLBI), parts of the National Institutes of Health (NIH).

Fluoride toothpaste is prohibitively expensive for the world’s poorest people, according to a study published in BioMed Central’s open access journal Globalization and Health. Researchers revealed that the poorest populations of developing countries have the least access to affordable toothpaste.

The team, which includes Ann Goldman of the School of Public Health and Health Services at the George Washington University in Washington D.C., Robert Yee and Christopher Holmgren of the World Health Organization Collaborating Centre at Radboud University Medical Centre in Nijmegen, The Netherlands, and Habib Benzian of the FDI World Dental Federation compared the relative affordability of fluoride toothpaste in 48 countries.

Globalization has led to a worldwide tendency to eat a more westernized diet, which is higher in carbohydrates and refined sugars. This has resulted in an increasing prevalence of tooth decay in developing countries, which can lead to malnutrition and a reduced quality of life. The cost and relative unavailability of dental care in poorer countries means that tooth decay usually remains untreated.

Fluoride toothpaste is the most widely used method of preventing dental decay, but currently only 12.5% of the world benefits from it. The researchers believe that the low-use of fluoride toothpaste is due to its cost, which is too high in some parts of the world. This study is the first to attempt to quantify the affordability of toothpaste across the globe.

Questionnaires regarding the cost of fluoride toothpaste were completed by dental associations, non-government oral health organisations and individuals around the world. The cost of a year’s worth of toothpaste for one person was calculated as both a proportion of household expenditure and in terms of the number of days of work needed to cover the cost.

The results showed that in different income groups in various countries, as the per capita income decreased, the proportion of income needed to purchase a year’s supply of toothpaste increased; the poorest in each country being the hardest hit.

“Because of the importance of fluoride toothpaste in preventing tooth decay, it must be made more available to the world’s poorest populations,” commented Goldman, “steps should be taken to make fluoride toothpaste more affordable and more accessible.” The authors suggest that this can be done by exempting fluoride toothpaste from taxation, encouraging the local manufacture of fluoride toothpaste and persuading multinational manufacturers to implement different pricing policies for poorer countries.

Oral ingestion of pomegranate extract reduces the production of chemicals that cause inflammation suggests a study published in BioMed Central’s open access Journal of Inflammation. The findings indicate that pomegranate extract may provide humans with relief of chronic inflammatory conditions.

The group from the Department of Medicine of Case Western Reserve University, Cleveland Ohio, led by Tariq Haqqi, showed that blood samples collected from rabbits fed pomegranate extract inhibited inflammation.

Pomegranate extract is already used as a treatment in alternative medicine for inflammatory conditions, such as arthritis. Although pomegranate extract has antioxidant and anti-inflammatory actions in experiments on isolated tissues, it is not known whether ingestion of it can produce the same anti-inflammatory effects in living systems, either because the active compounds are not absorbed from the gut or because the levels of these compounds in the blood are not high enough.

Pomegranate extract, the equivalent of 175mls of pomegranate juice, was given to rabbits orally. The levels of antioxidants were measured in blood samples obtained after drinking the pomegranate extract and compared to blood samples collected before ingestion of pomegranate extract.

Plasma collected from rabbits following ingestion of pomegranate extract contained significantly higher levels of antioxidants than samples collected before ingestion of pomegranate extract; the extract also significantly reduced the activity of proteins that cause inflammation, specifically cyclooxygenase-2. It also reduced the production of pro-inflammatory compounds produced by cells isolated from cartilage.

The results of this study indicate the beneficial effects of pomegranate extract when ingested. According to Haqqi “the use of dietary nutrients or drugs based on them as an adjunct in the treatment of chronic inflammatory conditions may benefit patients”. He adds that, “Current treatment with anti-inflammatory drugs can have serious side effects following long-term use. Further research is needed, however, especially on the absorption of orally ingested substances into the blood.”

A study of individuals with age-related macular degeneration (AMD), based at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, found that nearly 40 percent of those likely to benefit from specific vitamin/mineral supplements were either not taking the supplements or not using the recommended dosage.  The study also showed that some patients used high-dose supplements even in the absence of evidence that these would be effective for their levels of AMD or other eye conditions.  The ophthalmic researchers, led by Susan B. Bressler, M.D., concluded that AMD patients appear to lack a clear understanding of supplement use in AMD treatment, and that “improved patient education may be vital to maximize the potential” of this therapy.

The public health impact could be substantial: in the United States if the appropriate patients used the correct supplements, about 300,000 people could potentially avoid advanced AMD within a five year period.  At least eight million Americans are at risk for advanced AMD which can destroy the central vision needed to recognize faces, read, drive and enjoy daily life.  In 2001 the Age-Related Eye Disease Study (AREDS) reported findings on its clinical trial that identified a specific formula of antioxidants (vitamin C, vitamin E and beta-carotene) and zinc that reduced the probability of progression to advanced AMD by 25 percent— either the “wet” or central geographic atrophy forms—among individuals at risk.  Those who have AMD and smoke may need to use a formula that omits beta-carotene since high doses of this micronutrient have been associated with increased rates of lung cancer and mortality.  Though effective treatment for advanced AMD is available, it can be expensive and is limited to the “wet” form.  Also, since such treatment may not restore vision already lost to the illness, it remains important to use all effective approaches to preventing AMD progression.

The Wilmer Institute-based study surveyed 332 individuals who identified themselves as having AMD; the median participant age was 79 years.  Of these, 228 were considered candidates for benefit from the AREDS formula, but only 140 patients (61 percent) in this group were using the correct formula as recommended.  Nearly 50 percent of the candidates-for-benefit did not correctly answer questions on the relevance of vitamin/mineral supplements to their eye condition and how their vision might benefit.  But patients who indicated that they partially or fully understood the rationale for supplements were about twice as likely to be using the AREDS formula correctly.

A study from researchers at Children’s Hospital Boston published in Pediatrics found that a simple infection control intervention in elementary schools – disinfecting frequently-touched surfaces and using alcohol-based hand sanitizers – helped reduce illness-related student absenteeism.Illnesses caused by bacteria and viruses account for millions of lost school days each year.(1) According to Thomas Sandora, MD, MPH, a pediatric infectious diseases specialist at Children’s Hospital Boston, “The best ways to avoid common infections are cleaning your hands and preventing exposure to the germs that cause these illnesses. Our research indicates that elementary schools should consider a few simple infection control practices to help keep students healthier.”

The study, led by Dr. Sandora, was a randomized, controlled trial involving 285 third-, fourth-, and fifth-grade students in an elementary school system in Avon, Ohio. Teachers in intervention classrooms used disinfecting wipes on student desks, and students used hand sanitizer in the classroom at key points throughout the school day. Control classrooms followed usual hand washing and cleaning procedures.

Over eight weeks, researchers tracked the frequency of absences and the reasons for missing school. Study investigators also tested several classroom surfaces for total bacterial counts and for the presence of several common viruses.

Researchers found absenteeism rates for gastrointestinal illnesses were nine percent lower in classrooms that followed the infection control regimen of disinfecting surfaces and using alcohol-based hand sanitizers. The absenteeism rate for respiratory illness was not affected by this intervention.

Gastrointestinal illnesses are extremely common for school-age children, and children can be at risk for these infections because of frequent exposure to ill peers and poor hand hygiene.(1) In fact, the bacteria and viruses that cause these gastrointestinal infections can be easily passed from one person to another on the hands.(2) The germs can also survive on surfaces in the environment, where some of them can persist for hours to days.(1)

The study suggests that schools should consider adopting simple infection control practices, including disinfecting desktops once a day and using hand sanitizer before and after lunch, to help reduce days lost to common illnesses.

New research into the toxins, virulence, spread and prevention of the superbug Clostridium difficile is reported in the June special issue of the Journal of Medical Microbiology. These findings will play a crucial role in providing us with ammunition in the fight against a sometimes deadly pathogen.

Clostridium difficile is found in the environment but is most common in hospitals. It can cause a serious hospital-acquired infection when antibiotics are used as they upset the balance of the normal gut flora, allowing C. difficile to grow and produce toxins. It is carried in the guts of 3% of healthy humans but carriage rates in hospital patients tend to be much higher and elderly people in hospitals, being treated with antibiotics are most at risk of developing infection. The bacteria produce spores when they encounter unfavourable conditions. Transmission of infection is through the ingestion of these spores which can survive on surfaces and floors for years and are resistant to many disinfectants and antiseptics, including alcohol hand gel.

Symptoms include diarrhoea, nausea, abdominal pain, loss of appetite, fever, bowel inflammation and possible perforation, which can be fatal. Only two antibiotics are regularly used to treat C. difficile infection: metronidazole and vancomycin, but relapse is a common problem following treatment. In 2004, a hypervirulent strain (C. difficile 027/NAP1/BI) was reported, which appears to make toxins more rapidly and at higher levels than other strains, as well as being resistant to many antibiotics, including fluoroquinolones.

Several studies in the Journal of Medical Microbiology look at the spread of C. difficile in different countries, including Austria and Korea. Research shows that the use of antibiotic increased the risk of outbreaks of the hypervirulent strain of C. difficile in the Netherlands. The issue also contains evidence to suggest that C. difficile could be spread between animals and humans – researchers have isolated the bacterium from food animals in Slovenia.

Scientists investigated the effects of antibiotics, antigens and other agents on the virulence and pathogenicity of C. difficile. Toxins were also studied; research reveals some important information about the synthesis, processing and effects of different toxins. A new gene sequence has been discovered in the hypervirulent C. difficile 027 strain, which could be related to its increased virulence by affecting toxin binding.

The potential for a ‘designer’ probiotic for C. difficile is discussed. Professor Ian Poxton, former Editor-in-Chief of the Journal of Medical Microbiology said “this is an important approach that is hopefully much better than previously reported studies using commercially available yoghurt-like drinks, and certainly more palatable than ‘faecal transplants’.”

The attitudes of foodservice workers toward safety practices have a direct effect on foodborne illness occurrences in restaurants, according to researchers from Kansas State University.

The researchers surveyed 190 foodservice employees in 31 restaurants across three Midwestern states on their knowledge of and attitude toward three food safety measures that have the most substantial impact on public health: hand washing, using thermometers and proper handling of food contact surfaces. Only employees whose jobs directly involved food preparation tasks participated.

The researchers conclude that providing workers with training that does not target their attitudes may not improve food safety results. “While emphasis should be placed on training, it is also important to educate employees regarding positive outcomes of food safety such as decreasing patrons’ risk of food borne illness, reducing the spread of microorganisms and keeping the work environment clean.

The “Freshman 15,” the notion that students gain 15 pounds during their first year of college, may overstate students’ actual weight gain, according to researchers at the University of Guelph, Canada. In a sample of 116 first-year female students, the average weight gain was 5.29 pounds.

While the students reported gaining less weight than the “Freshman 15,” the researchers point out: “It is important to recognize that the increase of 5.29 lbs. occurred over a period of just six to seven months…Weight gain at this rate over an extended period of time could lead to overweight/obesity and is certainly cause for concern.”

The students completed a dietary assessment using diet and lifestyle questions adapted from the National Longitudinal Survey of Children and Youth (Canada) and the U.S. Centers for Disease Control and Prevention National Youth Risk Behavior Survey.

The study found students reported increases in their body mass index from an average of 22.3 to 23.1; average percent body fat went from 23.8 to 25.6; and average waist circumference increased from 30.27 to 31.25 inches.

The proportion of participants with BMI measurements classified as either normal or underweight decreased from 79 to 75 percent and from eight to six percent, respectively. The proportion of students who were classified as overweight (BMI above 25) increased from 15 percent to 22 percent, while those who were obese (BMI at or above 30) remained constant at 3 percent.

“From a basic science perspective, the advances being made in genomics are important discoveries, but it’s unrealistic for individuals to believe those advances can yield meaningful information that will improve their health,” said James P. Evans, M.D., Ph.D., professor of genetics and medicine in the UNC School of Medicine. “And even saying ‘It’s not there yet’ is too optimistic. It’s going to be a long time before the potential is realized.”

Evans, who is also the director of the cancer and adult genetics clinics and the Bryson Program in Human Genetics in UNC’s medical genetics department, will talk about how personal genomics will affect human lives at a panel discussion titled “Your Biological Biography” at the World Science Festival being held in New York City, May 28 to June 1. Evans will speak between 1 p.m. and 2:30 p.m. on Saturday, May 31, at the Kimmel Center for University Life at New York University.

“The sequencing of the human genome revealed that in relative terms, humans are 99.9 percent the same,” Evans said. “But in absolute terms, we are very different. For example, a one-thousandth of a difference in their respective DNA profiles translates into more than 3 million differences between any two unrelated individuals.”

Some of these differences are medically relevant, in that they influence disease predisposition and response to drugs, areas Evans studies in his research. And the differences are of interest in non-medical ways, specifically when they address ancestry, behavior traits and the innate curiosity humans have about their genes.

Sequencing of the human genome, which was completed in 2003, also gave rise to commercial entities offering direct-to-consumer genetic testing for a fee, usually between $1,000 and $3,000. Evans worries that individuals may seek such testing with the false hope that they will get meaningful results regarding their risks for disease and actionable medical advice about how to decrease their risks.

“Much of the current excitement about genetics and medical genomics is predicated on the idea that knowing our genomes better will improve our health,” Evans said. “In fact, for the vast majority of such risk assessments, the increased risk of an individual developing the disease in question is modest – one- to two-fold over baseline. And in few such conditions are there specific effective interventions to diminish the risk. Further, there is little evidence that having the specific genetic information would actually induce a change in lifestyle.”

Society has tended to place an almost mystical association on genetic information, Evans said, adding that what to do with this new knowledge and how to interpret the information presents many unanswered challenges.

“Most physicians, by their own admission, are not geneticists and won’t know what to do with the information,” said Evans, who uses family history and genetic testing to evaluate and counsel patients about their risk for cancer. “Many who do understand the technology and how it is generated don’t know what to do with it. So there’s huge potential for patient harm – either for patients to be lulled into a false sense of security by this new genomic information or, in the opposite extreme, to have unnecessarily increased anxiety.”

And Evans said he can see even more extreme measures “where interventions are implemented – for example, a total body scan – that put patients on a road to invasive tests that they are better off not getting.”

Evans believes these challenges say something about how humans value information, but then fail to scrutinize what it really means. “It’s hard for me to over-estimate the beauty and utter significance of sequencing the human genome and other animal genomes,” Evans said. “The technology is very promising for all of us, but there is a big gap between having that knowledge and applying it for the betterment of human health.”

Past research has found that patients enrolled in weight-management programs experience greater success as the frequency they meet with physicians or weight-loss counselors about their progress increases. The U.S. Preventative Services Task Force, an organization that recommends guidelines for primary care in the U.S, classifies two provider contacts with patients as intensive. A study by NiCole Keith, associate professor in the Department of Physical Education at Indiana University-Purdue University in Indianapolis, found that this current recommendation may not be intensive enough for low-income and disadvantaged populations.

Her study was conducted in an urban community health center in Indianapolis that primarily serves low-income and disadvantaged populations. The weight-management program, Take Charge Lite (TCL), was free to patients, funded by the Fairbanks Foundation and available to all patients 18 or older with a body mass index indicating they could be overweight or obese — equal to or above 25. The program was developed for English or Spanish-speaking patients and used input from physicians, administrators and patients of the clinic. If patients qualified, their physician gave them information about TCL and the program coach’s contact information. Once a patient phoned, a first visit was arranged at which the patient chose goals, weighed-in, and discussed different weight-loss strategies with the coach. Program participants could attend support groups, education or exercise classes, meet face-to-face with coaches, or have regular weigh-ins. Each of these activities qualified as a contact.

At the end of the program’s first year, the relationship between weight loss and number of contacts was evaluated. Patients with two or fewer contacts per month gained about a pound. Patients with three or four contacts per month lost about two pounds of weight and patients who had five contacts per month lost just over two pounds. Those with six or more contacts lost about five pounds and patients with more than 11 contacts per month lost about six pounds. Keith said the program will continue and that she’s optimistic about its impact. “TCL coaches helped patients find strategies tailored to patient needs and abilities to help with weight loss,” she said. “Indentifying factors associated with weight loss and program participation may improve weight loss services, maximize contact and lead to increased weight loss in this population.”