Marci Reiss: A Crucial Health Issue No One Wants to Talk About
Marci Reiss is a medical researcher and activist who wants to help the world with their digestion– and she’s not afraid to talk about it.
Marci Reiss is a medical researcher and activist who wants to help the world with their digestion– and she’s not afraid to talk about it.
Key concepts within the longstanding Jewish tradition provide insight into a historical Jewish approach to health and the provision of health care.
This summary of prominent concepts largely reflects the perspectives of the more liberal, progressive Jewish community.
Jewish writings are quite extensive on each topic. The reader must understand that this synopsis cannot fully capture the extraordinary depth and specificity of Jewish law and interpretation through history about Judaism, health, medicine, health care and related issues.
Our bodies belong to God
According to the historical Jewish tradition, our bodies (and everything else) belong to God. They are on loan to us during our lifetimes. Upon our deaths, they return to God. During our lifetimes, we have an obligation, a religious duty, to live lives of holiness and maintain our health as a way of taking good care of God’s property. Taking good care of our bodies is central to Judaism.
Maimonides, the great medieval physician, rabbi and philosopher, outlined obligations we would classify as health preservation strategies: A proper diet, getting sufficient exercise and sleep, maintaining good hygiene and having a healthy mind.
Jewish tradition embraces the idea that body and soul are integrated and that we use our complete selves to perform our obligations to God.
Equally important were obligations not to harm oneself or one’s body. Rabbi David Teutsch states that “keeping our bodies in tip-top shape is what some would call a prerequisite to mental and spiritual hygiene.”
Until more modern times, Jewish law required Jews to live in a community where there was a doctor, public baths and healthy food — specifically, fruit.
Created in God’s image
Jewish tradition holds that divinity is inherent in us. Just as in modern Western culture, Judaism focuses on the fundamental dignity of human life. Judaism strongly affirms that all members of society possess value and dignity. Jews are required to preserve the dignity of self and others. Taking care of oneself and healing others is a way to fulfill this obligation. Because poverty is an affront to the dignity inherent in us as God’s creations, all those who can are obliged to help.
Jewish tradition strongly protects those who are vulnerable and disenfranchised. Each person’s unique value is honored.
Rather than shrinking from differences, the early rabbis determined that one should be required to say a blessing upon seeing someone with a disability. The blessing honors our differences: “Praised are you, Lord our God, who created us as different.”
Jewish tradition also focuses on helping someone with a disability to be productive.
Our Torah ancestors lived long lives. As for aging, Jewish tradition affirms the meaning and wisdom that can occur in later life.
Spiritual development does not stop as one ages. It might intensify. Each person, regardless of age or physical or mental status, has value. We have an inherent responsibility to provide for future generations. Thomas Cole, a leading scholar of aging, health and the humanities, wrote: “One does not retire from the [Jewish] covenant, which provides a fundamental framework and obligation between God and the Jewish people.”
A human being is an integrated whole
Contrary to other Western religions, Jewish tradition asserts that the soul and the body are equally important.
According to Teutsch, “Jewish thought generally treats a living person’s body and soul as fully intertwined.”
Our bodies are as much the creations of God as our minds, wills and emotions. Care of our bodies as well as care of our souls is important.
Jewish tradition embraces the idea that body and soul are integrated and that we use our complete selves to perform our obligations to God. Shalom means “complete, harmonized well-being” in addition to peace. The rabbis understood there was no peace without harmony and well-being — an important concept for the individual and the community.
A daily prayer asking for healing of body and soul is written in the plural. Jews pray that we should all be healed.
Tradition focuses on healing mental health as well as physical health. Rabbinic interpretations maintained that mental health was to be treated as seriously as physical health, given the intricate link between human body and soul.
Saving a life
Pikuach nefesh embodies the Jewish obligation to save lives. Jews are obligated to do everything possible to save a life. Preserving a life takes precedence over almost all other Jewish laws. This obligation is embedded in the belief we are created in God’s image.
As Jews, we affirm God’s presence in the world by healing as many of God’s creations as possible.
The duty to heal
Jewish tradition emphasizes that the duty to heal is an obligation of each person. It must be balanced with the duties to provide other essential services, such as food, shelter and clothing. As opposed to the Declaration of Independence, which begins with inalienable rights, Judaism begins with duties, indeed God’s commandments.
Healing is considered “a duty one has to oneself and to others.” The Torah’s injunction to pursue justice is captured in the imperative in Deuteronomy, “Justice, justice thou shall pursue,” and is tied to communal healing and personal well-being.
Throughout Jewish history, the rabbis took this injunction seriously. Jewish tradition strongly focused on the importance of providing food, shelter, clothing and medical care to those in need, and to use a community’s resources wisely to balance their allocation and make sure the social safety net comprised all these primary needs.
The Jewish concept of tzedakah, “charitable giving in pursuit of justice,” is built on understanding that caring for others, particularly thepoor, is the right thing to do.
We each have the right to receive and the responsibility to provide health care. The Torah admonishes us not to harden our hearts nor shut our hands to the needy. The injunction to heal is for Jews and non-Jews alike.
Rabbi Nancy Epstein, associate professor in the Department of Community Health and Prevention at the Drexel University School of Public Health, worked in the public health field for 40 years.
Do you plan on traveling around the world this year? If so, I’m sure you’ll want to stay healthy at all times. It’s not a pleasant experience when you’re sick in foreign countries. Travel insurance won’t be able to help you out.
By the time you need it something will already be wrong. Instead, you should rely on gadgets to keep you safe. Especially those small enough to squeeze into your backpack. Let’s discuss a few good ones you’ll want to take with you.
These days, a good watch doesn’t just tell you the time. They can all do something a little special. Have you looked at the affordable watches for nurses they’re investing? You’ll love the features built into them.
Some come with a special secondhand designed to keep track of your vitals. You can turn to your watch if you think something is wrong. I’m sure you know it’s better to seek help before disaster strikes.
What will you do if you have to sit beside a screaming child on a bus? By the time you reach your destination your head will be sore. In fact, any time you have to endure loud noises it will affect you.
If you wear noise canceling earphones you’ll be able to keep the external sounds out. Listening to music is also more enjoyable when you can actually hear it. It’s a crucial piece of kit when you’re traveling.
Walk down the street and you’ll see everyone staring at their phones. It’s the same when you go traveling, which is kind of sad. If you’re out all day there is a good chance your phone battery will die.
What will you do if you need to call the emergency services? It’s a situation you never want to find yourself in. Carry a small backup battery around with you and you’ll always be able to call an ambulance.
You can’t carry hundreds of physical books with you. If you enjoy reading you’ll be forced to read digital books while you’re away. Don’t try to read them on your smartphone or tablet if you value your eyesight.
If you stare at a bright screen all day you’ll end up in tremendous pain. Your eyes will sting so much you won’t be able to see right. It’s worth investing in a Kindle Paperwhite because it’s similar to reading a paper book.
If you don’t drink enough water you’ll end up in big trouble. Drink unfiltered water in certain countries and it’s nearly as bad. You’ll be curled up in bed wishing you were still dying of thirst.
When you’re on your adventures you want to feel safe when drinking water 24 hours per day. The only way that will happen is if you carry an effectively filtered water bottle around with you.
Think carefully and you’ll be able to come up with even more gadgets you should take. Your health should be your number one priority. Hopefully, these suggestions have sparked your imagination.
Israeli researchers have developed a new therapy to treat atherosclerosis — the hardening and narrowing of the arteries — and prevent heart failure, using a new biomedical polymer that reduces arterial plaque and inflammation in the cardiovascular system.
Atherosclerotic cardiovascular disease causes 56 million deaths annually worldwide, according to the 2015 Lancet Global Burden of Disease Report.
Arteries are lined by a thin layer of cells, the endothelium, which keeps arteries toned and smooth and maintains blood flow. Atherosclerosis begins with damage to the endothelium, typically caused by high blood pressure, smoking or high cholesterol.
When endothelial cells become inflamed, they produce a molecule called E-selectin, which brings white blood cells (monocytes) to the area. That leads to dangerous plaque buildup in the arteries.
At present, there are several available treatment options for atherosclerosis, but no therapy can reverse arterial damage and improve the heart muscle. An innovative nano-polymer made in Israel shows promise in reducing arterial damage and improving the heart muscle.
This E-selectin-targeting polymer selectively repairs damaged tissue without harming healthy tissue, so it has no side effects — unlike statins, which currently are the leading medication used for treating atherosclerosis.
“Our E-selectin-targeting polymer reduces existing plaque and prevents further plaque progression and inflammation, preventing arterial thrombosis, ischemia, myocardial infarction and stroke,” said Ayelet David of the Ben-Gurion University of the Negev (BGU) department of clinical biochemistry and pharmacology.
Patented and in preclinical stage, the new polymer has been tested on mice with positive results.
In a study soon to be published, David and fellow researchers describe how they treated atherosclerotic mice with four injections of the new biomedical polymer and tested the change in their arteries after four weeks.
“We were stunned by the results,” said Dr. Jonathan Leor, director of the Cardiovascular Research Institute at Sheba Medical Center and professor of cardiology at Tel Aviv University, who collaborated with David on the research study.
“The myocardial function of the treated mice was greatly improved, there was less inflammation and a significant decrease in the thickness of the arteries,” Leor said.
David and Leor suggest that this polymer-based therapy also may be helpful to people with diabetes, hypertension and other age-related conditions.
As such, the new polymeric therapy may have life-changing benefits for millions of people, they said.
“We are now seeking a pharmaceutical company to bring our polymer therapy through the next stages of drug development and ultimately to market,” said Ora Horovitz, senior vice president of business development at BGN Technologies, BGU’s technology and commercialization company.
“We believe that this therapy has the potential to help a great number of people,” Horovitz said.
One week before Pesach, I sat in a hospital room in a Philadelphia intensive care unit. In that moment, I was not a rabbi. I was a brother.
I was there with my older brother, Eyal, who has been a quadriplegic for the past 32 years as the result of a brain stem tumor and stroke. He is completely broken physically. Over the years, there have been frequent hospitalizations. On this particular visit, we received the news that Eyal would need dialysis.
During times like these, my family has gained the uncanny ability to find Divine sparks outside of synagogue sanctuaries and community centers and inside the walls of hospitals, where the human soul is at its most vulnerable. These sacred moments are Torah study in action.
Someone once asked the Chazon Ish, a leading rabbinic scholar in the first half of the 20th century, if he thought it advisable to seek solitude in order to study Torah, without any distractions and interruptions. The rabbi answered, “My heart cannot believe that by being isolated from everyone you can acquire a true acquisition of Torah. It is quite obvious that society and friends will assist you.”
In fact, the midrash teaches that God commanded Moses to read Parashat Kedoshim in front of the entire assembly of people, because most of the essentials of the Torah are summarized within its holiness code. This includes the commandment to love your fellow human being (Leviticus 19:18), which can be fulfilled at all times, every single second of the day. This commandment can be fulfilled in action but also in thought. When you are happy about the good fortune of another, this is loving your fellow human being. The same applies for suffering. If you feel sad because of another person’s suffering, you fulfill this commandment.
In essence, holiness is a universal language. The Kotzker Rebbe once said, “Don’t only study Torah; be a Torah.” We must live out the prinicples taught to us by our tradition, both in joy and sorrow.
In my brother’s Philadelphia hospital room, we met Eyal’s dialysis nurse, Elaysha. After a brief introduction, she was silent for the next two hours, almost seeming upset at the world. My parents, siblings and I sat impatiently, waiting for the session to conclude.
Thankfully, my mother brought a piano keyboard to the hospital and asked me to lead a sing-along and lift everyone’s spirits. As we started to sing our favorite Jewish camp songs, Elaysha perked up and asked, “What type of music is that?”
“Jewish music,” I replied.
Elaysha told me she is a drummer in her church band, and I proceeded to let her know that she had walked into a room full of rabbis. Like me, my father, my sister and my wife all are rabbis. This fact did not scare her, but brought her closer to our sacred conversation.
Elaysha informed us that she comes from a family of pastors, but that she did not find her calling, as she is only a dialysis nurse. At that moment, as Elaysha administered dialysis to my brother, I told her, “Elaysha, there is no better calling than what you are doing: walking into a room with people who are spiritually and physically low, giving them the hope that they can be lifted up.”
For the next two hours, we spoke in a universal language. We shared our favorite biblical passages, and our best moments growing up as preachers’ kids. As the dialysis session concluded, we even sang a song, one that has been sung from synagogue and church pulpits alike: “Lord, prepare me to be a sanctuary.”
Is this not what Kedoshim teaches us?
Yes, many feel they must enter a sanctuary in order to find holiness, but the truth is that if we each try, we can be our own sanctuary, pure and holy, tried and true.
Elaysha left the room that evening, and my entire family felt blessed by her presence. While we have not seen her since, we have felt that Divine spark that she brought us on that day.
Those hours of holiness were not confined to a synagogue, school or even a home. Rather, that sacred time was the pinnacle of the philosophical thinking of the Chazon Ish — learn holiness in your sacred books, practice holiness in your sacred lives.
Hundreds of years earlier, the prophet Zechariah lived during a tumultuous time of Jewish history and yet preached a message of optimism. He said Jews are assirei tikvah, prisoners of hope. While a prisoner connotes being bound up to something else, Jews are bound with hope.
A hospital can be a scary place. Yet, a hospital is where we constantly see people expressing hope; a place where an angel like Elaysha enters your life for a brief moment, a place where we can fulfill the Torah’s command to strive for holiness today.
Rabbi Erez Sherman is a rabbi at Sinai Temple.
One in 5 school-age children in the United States is obese, and many others are overweight, according to the Centers for Disease Control and Prevention. And even children at what is considered a healthy weight aren’t necessarily healthy.
“There is no magic diet, no one diet that is good for everyone,” said Dr. Bahareh Michelle Schweiger, a pediatric endocrinologist at Cedars-Sinai Medical Center in Los Angeles.
Schweiger and Dr. Richard Brucker oversee the Step-Up Kids Weight Management Program at Cedars-Sinai. They and their colleagues, including certified diabetes educators (pre-diabetes and diabetes diagnoses in children are on the rise) work with children and their families to develop customized weight-loss and healthy-eating plans.
The Journal spoke with Schweiger — a Sherman Oaks resident, Valley Beth Shalom congregant and mother of three children — about changes families can make in their diets to improve their health. She offered the following suggestions:
Don’t Play Food Police
Going through the pantry when the kids are at school and tossing out every package of Oreo cookies and Cheez-It crackers may sound like a surefire strategy to prevent your kids from eating junk. But Schweiger advises against it. “Forbidding certain foods and trying to play police can actually be more of a draw for the kid to overeat those foods whenever they get a chance,” she said. Not to mention that it could set up an unhealthy relationship between you and your child. Instead, start with smaller, more manageable steps. And be a good role model.
Make It a Family Affair
Schweiger said she knows families are busier than ever, which often leads to eating on the fly and grabbing whatever is quick and easy. However, when families sit down to eat together, they tend to eat less-processed foods and share food that is higher in fiber. Your family can’t do weekday dinners? Try Saturday breakfast or lunch.
Involve your children, too. Let them choose their favorite fruits and vegetables at the market, or something they are open to trying, and enlist them to help prepare the meal. “They need to be part of the process,” Schweiger said. “Otherwise, there is going to be unwillingness to make any change.”
If your family likes to go out for the occasional treat, don’t go overboard. Everyone in the family can order a kiddie portion of ice cream.
Pay Attention to Portion Size
Portion sizes at some restaurants are four times bigger than what is healthy. So even if you eat only half of a serving, you could be consuming twice the portion size you really need, Schweiger said. So how do you figure out the proper serving of chicken or pasta or broccoli? Use your palm as an approximate measure, she said. And remember, since your child’s palm is likely smaller than yours, their portion size should be smaller, too.
Banish the Clean Plate Rule
Don’t expect children to eat everything on their plates. Conversely, parents should not be short-order cooks. If your child does not like what you make for dinner one night of the week, don’t whip up a special dinner just for them. If children are eating a variety of foods, they will manage. They can grab a piece of fresh fruit if they are famished.
Eat More Fruits and Vegetables
Half of your diet and your kids’ diets should be made up of fruits and vegetables. Research has found the fiber in fruits and vegetables helps to prevent certain cancers. And fruit juice isn’t a replacement. “Often, our brain doesn’t process those calories as food,” which can lead to weight issues, Schweiger said.
It can take 15, 20, even 30 introductions of a food for a child to learn to like it. A strategy to make fruits and vegetables more enticing is to serve them alongside something you know your child likes.
Eat a Healthy Breakfast
If there is one meal where many families go wrong, it is breakfast — or skipping it, Schweiger said. “You’ve already been fasting all night,” she said. “[Breakfast is] an important time to get some good nutrition in, especially before sending your kid to school. Get their metabolism up and going.” There’s research, too, that shows those who skip breakfast have an increased risk of obesity and pre-diabetes.
So what does a healthy breakfast look like? Schweiger suggests a piece of wheat toast with cream cheese, oatmeal, yogurt, or a hard-boiled egg, along with something else. Even some packaged breakfast bars are OK, she said. And cereal merits its own portion-size reminder, since many kids (and grown-ups) are in the habit of filling their bowls nearly to the brim, which could be two or three times the recommended portion, Schweiger said.
A quick snack can be healthy. Schweiger suggests a cheese stick or a portion of nuts, yogurt or hummus. Try putting out a plate of fresh fruit or veggies when you know your kids are going to be hungry — like when they get home from school. “They are more likely to grab it, as opposed to going to the cupboard and opening up a processed snack,” Schweiger said. If you are going to provide crackers or something similar, measure out a portion size and put it in a baggie. Eating directly out of a box is an invitation to overeat.
Also, make sure an after-school snack doesn’t turn into a full meal. It’s nice to be hungry come dinnertime.
Ditch the Electronics
Electronics and mealtime are not an ideal pairing. If your child has a smartphone, make sure it’s not part of the dinner party. That goes for Mom and Dad, too. If you are texting or watching YouTube videos at mealtime, you are not paying attention to the food you are eating and “You end up eating a lot more food,” Schweiger said.
Special Considerations for Jewish Kids
Protein should be a part of most meals. “It can help make you feel full longer and keep your blood sugar more stabilized,” Schweiger said. But some Jewish schools don’t allow students to bring meat in their lunches. If a child also has a nut allergy, it could make it difficult to get enough protein during the day. Schweiger recommends hummus and avocado as good sources of protein.
In keeping with the recommendation of the American Academy of Pediatrics, Schweiger said children should get 60 minutes of moderate physical activity a day. The exercise doesn’t need to be done at one time. It can include, for example, walking to school, playing at recess, or participating in a dance class.
Of course, many kids don’t walk to school, and some may spend their recess on their smartphone. If your child loves electronics, Schweiger recommends they do 15 minutes of “Just Dance,” a popular game available for various platforms, or even 20 jumping jacks here and there. She also is a fan of many exercise videos geared for children. One of her favorite series is “Instant Recess,” available on YouTube.
It is important to be patient when looking for weight-loss results.
“This isn’t a quick fix,” Schweiger said. “There are always ways to be healthier and eat healthier.”
It was supposed to be a joyous time.
Shane Gold Burwick, 31, of Encino, was in the prime of life. She recently had gotten married, had established a successful career licensing wireless content for Sony Pictures and was expecting her first child.
Then, tragedy stuck.
Unbeknownst to Burwick and her family, she had developed a blood-clotting condition called thrombophilia. After a few painful months and an eventual diagnosis, Burwick and her unborn son died in January 2010.
But the story doesn’t end there.
Burwick’s untimely death eventually gave life to a new passion and purpose for her family: educating the public and the medical community about blood-clotting disorders related to contraceptives, pregnancy and post-pregnancy. Led by Burwick’s mother, Roberta Gold, the family launched the Shane Foundation (shanefoundation.org) in October 2013 as a partner of the March of Dimes. Since then, Gold has become a leading expert on blood-clotting disorders affecting women. The foundation also is raising money to fund medical research in Israel that Gold hopes will help prevent women from suffering the same fate as her daughter.
“I felt that if I don’t do something, this anger, if you allow it to be directed inward, it’s extremely destructive on all levels,” Gold said in explaining her decision to start the foundation. “This was my only choice. [This condition] is horrifying, and the deeper I dug, the more horrified I became.”
Gold said that as she pored through medical studies and other information about blood-clotting disorders, she began to realize her daughter’s death was not the anomaly she at first believed. Thousands of other women, she discovered, also had suffered complications from blood clots during pregnancy that, for many, led to premature birth, miscarriage, stillbirth or their own death. In fact, Gold and her family became convinced that Burwick’s death could have been prevented if the medical community had been more knowledgeable about her condition and provided more proactive and effective treatment.
Burwick had shown signs of having a heightened risk for blood clots about 18 months before she conceived, when she survived a life-threatening blood clot in a lung after taking the oral contraceptive Yasmin. Gold believes the contraceptive, which lists blood clots among its possible side effects, initiated Burwick’s blood-clotting disorder. Had Burwick and her doctors been aware of the possible connection between her illness and the drug, Gold believes, her daughter’s subsequent problems could have been identified and treated successfully.
Blood clots are a leading cause of maternal death in the United States, according to the American Congress of Obstetricians and Gynecologists. A blood clot occurs when blood coagulates into a clump that partially or completely clogs a blood vessel. Blood clots can cause life-threatening damage to vital organs, such as the brain or lungs, and can interfere with the development of the fetus in pregnant women.
About 1 in 5 people in the United States has a blood-clotting disorder, which can be inherited or acquired later in life, according to the March of Dimes. Studies show certain contraceptives significantly increase the risk of blood clots, and pregnancy alone can increase a woman’s risk for blood clots because of changes in hormones and blood composition.
Despite the prevalence of blood-clotting disorders and the potential consequences for women and babies, doctors do not routinely test women to see if they are at risk. Burwick’s sister, Robyn Fener, who is the Shane Foundation’s executive director, said blood tests performed before prescribing contraceptives, during pregnancy or before moving forward with a cesarean section can help prevent blood clot-related tragedies. Doctors also should regularly ask women whether they have a family history of blood clots, she said.
To address these issues, the Shane Foundation has produced written materials on the subject for doctors and patients, and Gold and Fener have spoken to medical organizations around the country.
“The issue for us,” Gold said, “is how are these women going to be identified? How do you know if you’re one of those who should not take Yasmin, who should not take all the fourth-generation contraceptives? And, unfortunately, the only way we know now is when you’re suffering a pulmonary embolism and can’t breathe. And all of these things happened to Shane.”
But tests don’t always succeed in identifying women at risk of blood clots. That’s why the Shane Foundation is raising money to fund research at Hadassah Medical Center in Israel that Gold and Fener hope will lead to a better understanding of who is susceptible and ultimately to better treatment and prevention. They will be launching their fundraising efforts at Sinai Temple on May 16, with an initial goal of $40,000.
In recognition of her expertise, Gold recently was appointed a nationwide patient advocate for the Washington, D.C.-based Council on Patient Safety in Women’s Health Care. She also serves as a member of the California Maternal Quality Care Collaborative at Stanford University, which works to improve maternity care and prevent maternal and fetal deaths.
Gold said she’s beginning to see the foundation’s efforts pay off, with more doctors paying attention to the issue of contraceptive- and pregnancy-related blood clotting. Even so, she believes more public awareness of the problem is needed, a goal the foundation continues to pursue.
Gold said her work with the Shane Foundation has helped her channel her anger over her daughter’s death in a positive direction.
“Ultimately, there is no path that can be restorative on the levels that we really want, and that’s the worst thing to try to find a way to face,” she said. “We busy ourselves with this other direction, and because we’ve chosen the other direction, we have seen and are seeing tremendous progress.”
JERUSALEM (JTA) — Israel’s first-ever national survey of iodine levels in the population revealed widespread deficiencies, which could mean millions of children are at risk of stunted development.
The survey, whose unpublished results were presented last week to endocrinologists in Ramat Gan, found that 62 percent of school-age children and 85 percent of pregnant women have iodine levels below the World Health Organization minimum.
According to the researchers behind the survey, Israel appears to have one of the highest rates of iodine deficiency in the world. The national health problem is likely related to Israel’s world-leading use of water desalination, they said.
“We could be talking about a significant detriment across the population,” Dr. Aron Troen, a nutritional neuroscientist at the Hebrew University of Jerusalem who helped lead the survey, told JTA. “For anyone below the minimum level, you may lose 7 to 10 to 12 IQ points, which translates into a huge decrease in GDP due to reduced productivity.
“We are concerned that increased reliance on desalinated water in the Israeli food chain is contributing to iodine insufficiency in the population.”
Even mild iodine deficiency can limit intellectual development. In the womb or early childhood, deficiency has been shown to impair brain development and in severe cases cause physical malformation, dwarfism and intellectual disability. Previous studies have found the children of iodine-deficient mothers perform much more poorly in school.
Researchers from Hebrew University, Maccabi Healthcare Service, Barzilai University Medical Center in Ashkelon and ETH Zurich in Switzerland collaborated on the survey, which analyzed urine samples from 1,023 school-age children and 1,074 pregnant women. They found similar results among Israeli Arabs, secular Jews and Orthodox Jews.
Based on their findings, the researchers called on the Israeli government to mandate the addition of iodine to salt or other foods, as do many other countries, including the United States. They said the change would be easy, inexpensive and have potentially large public health benefits. They also called for regular monitoring of national iodine levels.
In the meantime, Israelis can change their diets, including by buying iodized salt, which is currently expensive and hard to find in Israel.
“Individuals can improve their iodine status through increased consumption of iodine-rich foods such as milk, dairy and saltwater fish. They can also replace regular table salt with iodized salt,” Yaniv Ovadia, the doctoral student and registered dietitian who performed the survey, said in a statement.
Israel was one of only a few countries to have never before gathered nationally representative data on its residents’ iodine levels. But Troen said “the trajectory” of his research suggests the problem has worsened in recent years and may be related to Israel’s pioneering use of water desalination, which removes iodine as well as other minerals. About half of the water Israelis consume is desalinated – a higher percentage than in any other country.
In a study last year, Troen and fellow researchers found a “surprisingly high” prevalence of insufficient iodine intake among the residents of the southern Israeli city of Ashkelon, where residents get much of their water from the local desalination plant. They also found a strong association with thyroid dysfunction among adults and evidence that the problem increased in the 2000s, as Israel was ramping up its water desalination program.
According to data from the Israel Center of Disease Control, self-reported use of thyroid medication among Israeli adults increased 63 percent between the Israeli National Health Interview Surveys of 2003-04 and 2007-10.
Troen said other potential explanations for Israelis’ iodine deficiency are increased consumption of processed foods and surprisingly low consumption of dairy products. The scarcity of iodine-enriched salt and other food is certainly a factor as well, he said. Troen has started new research on the causes of iodine deficiency in Israel.
Ruth Bader Ginsburg isn’t getting any younger. As the Jewish Supreme Court justice comes up on her 84th birthday next month, many of her fans are praying that she lives through the Trump presidency.
It isn’t hard to tell how Ginsburg herself feels about the current political situation. In an interview with the BBC last week, she avoided mentioning President Trump by name — as she did last July, when she was harshly criticized for lambasting the former real estate magnate before the election — but said that the U.S. is not “experiencing the best of times” right now. She also said she is worried about the freedom of the press, argued that the current Congress is “not working” and praised the recent Women’s March on Washington.
But she has already been a darling for a long time among liberals — who have recently started begging her to eat more kale and keep track of her bone density so that she might have a better chance of staying on the court for at least the next four years.
There is one thing that should calm these nervous RBG supporters: Twice a week, she completes a grueling, all-body workout devised by a former army reserves sergeant.
On Monday, Politico’s Ben Schreckinger published a first-hand account of what Ginsburg’s workout feels like. He met with Ginsburg’s personal trainer, Bryant Johnson — who also trains the court’s other Jewish justices, Stephen Breyer and Elena Kagan — and completed the Ginsburg workout in an excruciating 90-minute session.
“I’m no athlete, but I’m young and reasonably fit. I thought the workout would be pattycake, but it was much harder than I expected,” Schreckinger wrote.
Below is an outline of all the exercises Schreckinger mentions in his article. It may not make you wise enough to decipher a federal court case, but it will likely make you stronger. (Although, if you complete it while watching “PBS NewsHour,” like Johnson says Ginsburg does, you may have a pretty good grasp of current events.)
(All exercises include three sets of 10-13 repetitions)
Whether to assimilate or meet a specific standard of American beauty, generations of Jewish teens and young adults have turned to rhinoplasty and other cosmetic surgeries in hopes of improving their career, romantic prospects or social acceptance.
More recently, however, as Jewish patients redefine their notions of beauty, Los Angeles area Jewish plastic surgeons are changing the way they communicate with their patients about what cosmetic surgery — if any — should be done.
These doctors report they also are getting a new wave of Jewish baby boomer clients who have had second thoughts about rhinoplasties done earlier in their lives. Whether they acquired the “button” nose (a standard nose job “style” from the mid-20th century) or something a bit more natural done recently, they want to rediscover their identity by having their original nose reconstructed.
“It’s the Jennifer Grey effect,” Dr. Alexander Z. Rivkin explained, referring to the Jewish actress whose rhinoplasty affected her appearance dramatically. “[My patients] felt like they had lost their uniqueness, a part of their body that connected them to their family and heritage.”
“Mark,” a New York native and California transplant, experienced this effect. After finding success during the 1980s San Francisco tech boom, he decided to have a nose job, thinking it would enhance his status and acceptance in the comparatively less-Jewish milieu of the Bay Area.
“I used to have a Bob Dylan nose, not large but clearly Semitic,” he said. “After the nose job, my cousin told me I looked like an Episcopalian.”
Even after a successful procedure, Mark realized he no longer looked like himself. When a music industry job brought him to Los Angeles a few years later, he embraced the city’s larger Jewish community but felt guilty about his nose job. Fully comfortable in his Jewish skin, he found he wanted his old nose back.
The procedure, revision rhinoplasty, can cost from about $14,000 to $24,000, depending on the surgeon, location and specific techniques required. According to Mark’s Beverly Hills-based doctor, Behrooz Torkian, the rebuilding of ethnic features involves using grafts from cartilage elsewhere in the body, such as an ear or a piece of rib, to re-establish features of the nose that were removed. Reversal procedures, he said, are performed more often for Ashkenazi Jews who received “cookie cutter” noses that did not fit their faces in the days before computer imaging.
“Mark’s story resonated with me because I think the worst thing that can be done to a face is to change it in such a way that does not respect its original anatomy or the ethnic features of the face,” Torkian said.
Rivkin, a Westside surgeon and assistant clinical professor at the David Geffen School of Medicine at UCLA, started offering a less invasive and expensive alternative to revision rhinoplasty 13 years ago in response to Jewish patients who said they felt as if they had lost a critical part of themselves when they had their ethnic bump shaved down.
The procedure, which involves injected cosmetic fillers, ranges from $2,000 for a temporary procedure lasting up to 18 months to $4,000 for a “permanent” procedure, lasting 10 years or more.
Dr. Nima Shemirani, a Beverly Hills facial plastic surgeon, said although younger Jewish patients explore rhinoplasty and other procedures to fit Hollywood ideals of beauty, future generations will be more accepting of their natural ethnic features. He recommends beginning the “Why rhinoplasty?” conversation earlier in life with a board-certified practitioner, especially because revision rhinoplasty is always more complex than primary rhinoplasty, with double the healing time — especially for Middle Eastern and Sephardic Jews.
“A rhinoplasty can be more drastic for these patients and take away ethnic features which may be desirable as they get older,” Shemirani said. “Ashkenazi Jews have more Caucasian features and, therefore, a rhinoplasty can simply help enhance their looks without losing their ethnicity. Even so, we like to catch patients before they make the mistake of getting a nose that doesn’t match their face.”
Torkian pointed out that the standardized “button,” “cookie cutter” or “pixie” nose associated with baby boomer patients does not match up with many other Jewish features and, therefore, telegraphs that a procedure has been done.
However, with advances in preoperative imaging and surgical techniques, today’s primary and revision procedures reflect a more ethnically sensitive approach to the face as a whole. While these advances give the advantage to patients undergoing surgery for the first time, they also have sparked a
trend among patients who previously had not had the opportunity to avoid the “cookie cutter” nose.
“We live in a world in which cultural tolerance and religious sensitivity are greater than they have been in the past,” Torkian said. “I think the desire to keep some cultural or ethnic features is multifaceted and complex, but it appears that people generally are embracing their heritage, are proud of it, and want to ensure not to completely wipe it off of their faces.”
A combination of virtual reality and treadmill training may prove effective in preventing dangerous falls associated with aging, Parkinson’s disease, mild cognitive impairment or dementia, according to an Israeli study published in the medical journal The Lancet.
The intervention described in the study combines the physical and cognitive aspects of walking, and could be implemented in gyms, rehabilitation centers and nursing homes to improve walking skills and prevent the falls of older adults and those with movement disorders.
“Falls often start a vicious cycle with many negative health consequences,” said co-lead author Anat Mirelman, a professor at Tel Aviv University’s Sackler School of Medicine who also works at Tel Aviv Sourasky Medical Center’s Center for the Study of Movement, Cognition and Mobility.
“The ability of older people to negotiate obstacles can be impaired because of age-related decline in cognitive abilities like motor planning, divided attention, executive control and judgment,” she said.
“Current interventions typically focus almost exclusively on improving muscle strength, balance and gait. Our approach helps improve both physical mobility and cognitive aspects that are important for safe walking,” she continued. “We found that virtual reality plus treadmill training helped to reduce fall frequency and fall risk for at least six months after training — significantly more than treadmill training alone. This suggests that our use of virtual reality successfully targeted the cognitive aspects of safe ambulation to reduce the risk of falls.”
Mirelman and professor Jeffrey Hausdorff, with their Israeli research team, in collaboration with partners across Europe, collected data from 282 participants at five clinical sites in Belgium, Israel, Italy, the Netherlands and the United Kingdom between 2013 and 2015. The participants, all ages 60-90, were able to walk at least five minutes unassisted, were on stable medications and had reported at least two falls in the six months prior to the start of the study. Nearly half of all participants had Parkinson’s disease and 43 had mild cognitive impairment.
Participants were assigned to treadmill training with virtual reality or treadmill training alone. The virtual reality component consisted of a camera that captured the movement of participants’ feet and projected it onto a screen in front of the treadmill, so that participants could “see” their feet walking on the screen in real time.
The game-like simulation was designed to reduce the risk of falls in older adults by including real-life challenges such as avoiding and stepping over obstacles like puddles or hurdles and navigating pathways. It also provided motivation by providing feedback on performance and scores on the game.
While the incidence of falls was similar in the two groups prior to the intervention, six months after training the rate of falls dropped by almost 50 percent among those who trained with virtual reality. In contrast, there was no significant reduction in fall rates among subjects who did not train with virtual reality.
“Interestingly, when we asked people if they enjoyed the treatment program, participants in the virtual reality group reported higher scores on user satisfaction questionnaires and a greater desire to continue to exercise with the ‘game,’ ” Hausdorff said.
“This suggests that the virtual reality not only led to fewer falls, it was also more likely to be used in the long term. Exercise needs to be fun and effective if it is going to be used continually.”
Parkinson’s patients improved most
Hausdorff said the biggest improvement was seen in participants with Parkinson’s disease.
“It was very exciting to see such improvement in the presence of a neurodegenerative disease,” he said. “Still, we need to conduct further research to verify the results and better understand why the fall rates were so responsive in the people with Parkinson’s disease.”
Mirelman noted that treadmills are widely available, and the additional cost of treadmill training plus virtual reality is about $4,500.
“The low cost could permit this approach to be widely used in various settings,” she said. “Future studies need to examine whether treadmill training plus virtual reality could be used as part of a prevention package to treat fall risk before falls become common and before injuries occur.”
When it comes to the health of boomers — those born between 1946 and 1964 — there’s both bad news and good. The bad news is that, try as we might, this generation cannot stop the march of time and will increasingly face chronic medical issues that tend to develop with age, including heart disease, cancer and diabetes.
The good news is twofold: Research demonstrates that boomers can significantly lower the risk of developing many of these health conditions by eating healthfully, staying physically active and avoiding tobacco.
It also helps that scientists are pursuing a vast array of efforts to combat or treat these conditions. Here is a sampling of encouraging developments locally and in Israel that should give hope to boomers.
Heart disease risk increases significantly for those 45 and older, and it’s the leading cause of death for adults older than 60. The heart cannot regrow tissue damaged by a heart attack, but researchers are exploring how to help damaged hearts regenerate tissue, as well as creating materials to enhance heart function.
At the Weizmann Institute of Science in Rehovot, Israel, Professor Eldad Tzahor and his colleagues were able to regenerate heart cells in mice by temporarily activating a protein involved in embryonic heart development. “Much more research will be required to see if this principle could be applied to the human heart,” Tzahor said in an Institute bulletin, “but our findings are proof that it may be possible.”
Dr. Ronen Beeri, director of Hadassah Medical Center’s Cardiovascular Research Center, is collaborating with colleagues at Mount Sinai Hospital in New York to use gene therapy to replace failing heart cells. They are using viruses to transport specific genetic material into the heart cell.
A “cyborg heart patch” combining living tissue with integrated electronics has been created by Tel Aviv University professor Tal Dvir and doctoral student Ron Feiner. The material can expand and contract like human heart tissue, while regulating itself like a machine. “We expect this to move cardiac research forward in a big way,” Dvir said in a news release. He believes the patch, along with sensors, could be used to send data about the heart to a physician or even eventually to administer treatment, for example, by releasing anti-inflammatory drugs if it senses inflammation.
Here in Los Angeles, researchers at the Cedars-Sinai Heart Institute have identified a possible way to address a common but difficult-to-treat type of heart failure that occurs when the heart muscle is so stiff that the heart cannot fill with blood. Laboratory rats with hypertension and this specific type of heart failure regained heart-pumping function after receiving infusions of cardiac stem cells.
Cancer is the second-leading cause of death in the United States, and 86 percent of cases in this country are diagnosed among those 50 years and older. A developing approach in cancer treatment called immunotherapy harnesses the body’s own immune system to fight the disease.
At UCLA, investigators are testing an immunotherapy drug for advanced melanoma, the most aggressive and deadliest type of skin cancer. The drug “releases the brakes” on the body’s immune system, enabling it to recognize and attack cancer cells. UCLA is one of six national cancer centers comprising the Parker Institute for Cancer Immunotherapy, a collaboration launched this year to maximize the potential of cancer immunotherapy research.
Weizmann Institute professors Yoram Salomon and Avigdor Scherz have helped to pioneer a new therapy for treating early-stage prostate cancer that involves using a laser in combination with a new drug, called TOOKAD Soluble. Patients receive the drug intravenously, then immediately undergo infrared radiation administered via thin optic fibers inserted into the cancerous tissue. The 90-minute procedure allows for treating large, deeply embedded cancerous tissues, and the minimally invasive approach appears to decrease side effects.
At the Keck School of Medicine of USC, Dr. Gabriel Zada was among California’s earliest adopters and teachers of a new approach enabling the removal of deeply embedded (sub-cortical) brain tumors. The NICO BrainPath is a tool combining imaging and navigation technology with an instrument that’s about the width of a highlighter with a tip the diameter of a pencil tip. The instrument can gently spread brain tissue without damaging the cortex (gray matter) and brain fibers. “It’s a highly accurate way of finding and accessing deeper brain lesions while protecting all the important superficial layers,” Zada told the Journal. “Now we can get to tumors or blood clots in a safer way than we could before.”
Type 2 diabetes
Boomers will be happy to learn that researchers at Ben-Gurion University of the Negev in Beersheba report that having a daily glass of red wine helps people with Type 2 diabetes moderately reduce cholesterol and improve cardiac health. Individuals with diabetes are at higher risk of cardiovascular disease and have lower levels of “good cholesterol.” Professor Iris Shai was principal investigator of the two-year trial, which also involved Harvard University and two European institutions.
Students in Hebrew University’s BioDesign program paired pressure-sensing socks with smartphones to reduce foot ulcers in diabetic patients.
Another challenge facing many people with diabetes is foot ulcers attributed to nerve damage that diminishes sensation in the feet. Members of the BioDesign: Medical Innovation program, created by The Hebrew University of Jerusalem and Hadassah Medical Center, developed an innovative way to address this problem. Hebrew University’s Danny Bavli and doctoral student Sagi Frishman, along with Hadassah’s Dr. David Morgenstern created SenseGO pressure-sensing socks. The machine-washable socks register pressure and send signals to a smartphone app that can alert patients to problems, helping them to avoid developing foot wounds.
In the past year, an estimated 6.7 percent of the U.S. adult population — or about 1 in 15 — had at least one major depressive episode, according to the National Institute of Mental Health. Depression affects around 6 million Americans ages 65 or older.
At UCLA, researchers are looking to the brain’s electrical system to develop and fine-tune treatment for depression. They are using an approach called neuromodulation, applying magnetic or electrical energy to modify the brain’s signaling processes.
“Traditionally, we think of treating depression with chemicals that affect how individual nerve cells function,” Dr. Andrew Leuchter told the Journal. “The latest treatments … use a source of energy … to reset the mood regulating networks of the brain … and frequently restore normal moods in patients with depression.”
One form of this treatment, called transcranial magnetic stimulation (TMS), involves placing an electromagnet on the scalp to pulse the brain’s mood-regulating area with electromagnetic energy. Leuchter says that about 60 percent of patients who failed to respond to antidepressant medication received “substantial benefit” when combining medication with this noninvasive treatment.
Researchers at Hebrew University found that targeting a certain type of brain cell, called microglia, may provide a new avenue for treating depression. Comprising roughly 10 percent of brain cells, microglia carry out immune system functions in the brain. Professor Raz Yirmiya and his team, along with researchers at the University of Colorado, Boulder, found that microglia also cause symptoms of depression in response to stress. Blocking the stress-response activation of these cells in mice halted their symptoms of depression. The findings, Yirmiya said in a media release, “suggest new avenues for drug research, in which microglia stimulators could serve as fast-acting anti-depressants in some … conditions.”
Of the estimated 5.4 million Americans who have Alzheimer’s disease, all but about 200,000 of them are age 65 and older. According to the Alzheimer’s Association, the number of seniors with Alzheimer’s is projected to reach 7.1 million by 2025, a 40 percent increase over this year’s figure.
By the time symptoms of Alzheimer’s appear, the patient may have been developing the disease for as long as two decades. At Cedars-Sinai, researchers are focusing on preventing the disease and detecting it early. The Cedars-Sinai Alzheimer’s Prevention Program includes an 18-month study looking at whether lifestyle changes can slow the buildup of amyloid plaque, the destructive brain plaque typical of Alzheimer’s, in patients with mild cognitive impairment or a family history of dementia. The program recommends lifestyle changes including eating a Mediterranean diet, exercising regularly, reducing stress and getting adequate sleep.
In addition, Cedars-Sinai researchers have developed optical imaging technology used in a device with potential to detect Alzheimer’s years before symptoms develop. The retinal imaging device detects amyloid plaques in the retina, which may precede the development of plaque in the brain.
Researchers at Tel Aviv University, the Technion-Israel Institute of Technology (Rambam Medical Center) and Harvard University are investigating the possibility of detecting Alzheimer’s via a blood test. They identified a specific protein found in high levels in individuals with cognitive decline. The next step will be to take these findings into clinical trials with the hope of eventually creating a “pre-Alzheimer’s test” to identify individuals who would benefit from early intervention measures.
The risk of severe eye problems increases significantly with age, especially in those older than 65. According to the American Foundation for the Blind, experts predict that rates of vision loss to double by 2030 because of the country’s aging population.
Hebrew University Professor Uri Banin and graduate student Nir Waiskopf have developed an artificial retina that absorbs light and stimulates neurons. It is hoped that the wireless implant might be used in the future to create a prosthetic device to replace damaged retinal cells in those who are blind.
Bar-Ilan University researchers also are working on a way to help the blind to “see.” Professor Zeev Zalevsky, along with Sheba Medical Center professor Michael Belkin, have developed a prototype contact lens that processes digital images and translates them into tactile sensations. The cornea can feel these sensations, helping wearers form a picture of their physical surroundings.
Also at Bar-Ilan, Dr. Yossi Mandel and researchers at Stanford University have developed a device that enables patients with glaucoma to monitor the fluid pressure inside their eyes using an implanted lens and a smartphone. The hope is that this technology will relieve the burden of visiting the ophthalmologist for frequent pressure tests, as well as provide a source of more frequent and reliable data.
The hospice patient, an innovative leader in his profession, was in his last moments of life. His eyes rolled back into his head, and his breath began to catch in his throat. His devoted wife was not ready for him to go. She climbed up onto his bed, grabbed him by the lapels of his pajamas and shook him, screaming “No! Do not leave me!”
The patient’s gaze returned, and, as his wife later described it, she could see through his eyes into eternity. They held each other’s gaze for several minutes, and then his eyes closed for good. He was gone.
The wife told this story at the patient’s funeral, feeling that it captured something important about her beloved. She was pleased. But our ancient rabbis and commentators, I thought to myself, would have been shocked. For them, this is not the proper way to treat someone as they die.
Judaism is very clear about the precious, holy time of transitioning from this world into the next. Known in medical circles as “actively dying,” it is characterized by raspy breathing, slowing vital signs, and a lack of interest in food and water. It can last from a few hours to several days.
Judaism has a name for this important stage of life: goses (rhymes with “no less”). As it says in the Talmud (Shabbat 151b), when someone is a goses, they are like a candle whose flame is flickering — if you reach out to touch it, you may put it out.
So many people today die in hospital rooms, surrounded by beeping machines, yammering televisions, and teams of medical professionals that flood in to administer electric shocks and break bones. This all flies in the face of what Judaism says God wants us to be doing for the dying patient.
Of course, there are times when modern medical interventions are appropriate to “save” a patient from death, but suffice it to say there are times when it can do no one any good. It is in the latter situation, when the end of life is nigh, that Jewish teachings want caregivers to adopt a very specific attitude: Keep at the forefront of your mind the idea that any action could either hasten or delay death, so it should not be taken. This is a time for self-restraint. Be tender and quiet, and let the death follow its natural trajectory. Let go, so that the patient can as well.
The rules of goses, and how I suggest the Jewish families I work with observe them (when they are open to them), are as follows:
• Minimize sound. Turn off machines and televisions. Speak quietly. Play only quiet, gentle music or sing sweetly to the patient.
• Minimize touch. Gentle kisses and strokes are fine, as is dabbing the patient’s mouth with a wet sponge to keep it moist. But do not shake, jab, squeeze or move them. Don’t call 911 and rush them to the emergency room, nor rush them home from the hospital (lest they die in the ambulance). Don’t even change their pillow or their diaper — unless you are confident that it is an impediment to comfort and ease that needs to be removed.
• Do nothing bracing. Do not wipe the patient with a wet washcloth or put an ice cube in their mouth. Do not squeeze or pinch them, such as with a blood pressure cuff or an IV needle. It is clear that they are dying; it is not necessary to track each step of it on a medical chart. Hospice nurses should be amenable once you explain that this is a religious preference. But if the patient is in a hospital, it may take stationing someone in the room to negotiate and actively refuse interruptions to the patient’s peace.
• Speak gently. Offer words of reassurance. Do not order the patient not to die, nor to die today. Tell them everything is fine with you, and that they are safe, and that death will be the right thing for them to do, when they are ready to do it. All is well.
I have known people who held on long after they should have died — for months — even though they were being tortured by their health condition. It seemed they were fulfilling a demand, telegraphed to them by their families, not to leave. It’s just not a fair thing to ask.
Dying is not inconceivable or bizarre. We have made it a taboo in our culture, but dying is just as normal and normative as having sex, giving birth or even going to the bathroom. It is something we need to relax and let our bodies do. We need not fear it. It will come when the time is right, and then it will be up to everyone to face it with respect, and let it unfold with grace.
The Talmud (Ketubot 104a) tells the story of Rabbi Judah, who was dying and in pain, but who was so beloved by the community that the rabbis declared a public fast and offered prayers, day and night, to keep him among the living. His housekeeper saw his suffering, however, and interceded. She threw a jar off the roof, and the praying rabbis paused in unison. In the silence, the rabbi died.
The story is told in praise of the housekeeper. The commotion and pleading of the rabbis was in its own way torture to Rabbi Judah’s soul. It just needed some peace and quiet so it could move on.
The rabbis of old may have had it easy, believing as they did that even reaching out and closing the eyes of a goses could be punished in the afterlife as murder. Today, it takes real bravery to contain one’s inclination to interfere.
Perhaps remembering the rules of goses, and the needs of the soul to return to That From Which We Came, can help give us this strength.
Rabbi Avivah W. Erlick is a board-certified health care chaplain working in home hospice and institutional settings. She owns a referral agency for clergy in private practice (lacommunitychaplaincy.com), and is a provider of creative Jewish after-death ritual (sacred-waters.com).
Doctors, dignitaries and officials representing Israel and California convened at Cedars-Sinai Medical Center on Feb. 8 to witness the signing of an agreement between Israel’s Ministry of Science and the California Institute for Regenerative Medicine (CIRM) to collaborate on stem cell research. It follows a 2014 Memorandum of Understanding to promote collaboration and innovation between Israel and California.
“Stem cell research is a cutting-edge field full of promise and opportunity. Who better to forge new ground together than the State of Israel and the State of California?” Israeli Minister of Science, Technology and Space Ofir Akunis said. “Both are hotbeds of innovation, medical research and technological invention and have a strong commitment to science as a means to improve the lot of all humanity … and creating a brighter future for us all.”
Stem cells are cells in the body that have the ability to renew themselves. Some stem cells can form other cells that make up different types of tissues and organs in the body. As such, they can act as a repair system for the body, replenishing adult tissues.
CIRM Chairman Jonathan Thomas said he was inspired to reach out to Israel after hearing Israeli stem cell scientists speak at City of Hope’s annual conference in November 2011.
“If a scientist in Israel is working on something that another scientist in California is working on,” Thomas explained, “they can jointly propose to CIRM for funding, and if they pass peer review and are approved, they will be jointly funded by us for the California scientist and the government of Israel for the Israeli scientist.
“Also,” he continued, “we are actively looking for projects from around the world to encourage them to develop a California nexus to what they’re doing. If there’s a project in Israel that requires multiple clinical trials, we could encourage them to come to Cedars and they could apply to CIRM for funding. That way, we help to develop the best projects.”
Although it is not specifically involved in the agreement, Cedars-Sinai “has made a major commitment to stem cell research,” Senior Vice President and Dean Shlomo Melmed said. “Our scientists have shown that stem cell technology can help reverse heart attack damage, the effects of macular degeneration, joint damage including osteoporosis-related fractures, and we’re about to embark on very promising early clinical trials for treating ALS.”
The therapy’s possibilities hit home when Julian A. Gold, Beverly Hills mayor and co-chair of Cedars-Sinai’s anesthesiology department, announced that he had a stem cell transplant nine years ago to treat leukemia. “I am standing here as evidence of the benefits of stem cells,” he said.
David Siegel, the American-born consul general of Israel to the U.S., talked about Israel’s history of success in stem cell research. “We are very well positioned to achieve breakthroughs very quickly and move very quickly on clinical trials therapies. With funding and through these partnerships with American companies, we can have quick FDA approval. For Israel, CIRM is like oxygen.”
The benefit will be mutual. “We will bring the minds and technology from Israel here. We’re creating jobs here in America,” said Israeli-American Council National Chairman Adam Milstein, whose organization aims to strengthen the bond between Israelis and Americans and “ensure Jewish and Israeli identity for future generations.” He also sees the stem cell agreement and others as a vital step in countering the anti-Israel Boycott, Divestment and Sanctions (BDS) movement.
“With this scientific and technical partnership showing the Israel behind the conflict to the world, we can fight BDS head-on,” he said, noting that other agreements are forthcoming in the areas of cybersecurity, biotech and water issues such as drought, a particular concern in California.
“Five years ago, very few people understood that Israel could be the key to solving the water problem in the world, and now because of these agreements, we have more visibility and more people are taking notice,” Siegel said, noting a growing interest in partnerships from other states, companies and academic institutions.
Akunis is setting his sights globally. “The beauty of Israel is high-tech innovation, and the cooperation will be not only with the United States and Europe but places like China, South Korea, Japan, India, Vietnam, all over the world,” he said. “We want to continue to lead the world in technology.” Public schools in Israel stress science and provide a tablet for every student.
For Israel, the benefits of international partnerships are vital. “These agreements are a way to put and keep Israel on the map in a very significant way, for our companies and for Israel’s ability to grow and protect itself,” Siegel said. “Israel is under political attack from our enemies and opponents around the world. One of the ways to fight that is by partnering with countries like the United States and states like California.”
A groundbreaking study carried out in Haifa suggests that regularly talking on a cellphone for more than an hour a day, and talking on the phone when it is connected to a charger, doubles the likelihood of a decrease in sperm concentration from 33.3 percent to 66.7 percent.
The study also indicates that sperm concentration decreases to an abnormal level in men who carry their phone at a distance of less than 20 inches from the groin. An abnormal concentration was found in about 47 percent of men who carry the phone at a close distance, compared with about 11 percent in the total male population.
The findings, reported in Reproductive BioMedicine Online, support a long-held suspicion of a link between cellphone use and male infertility caused by radio frequency electromagnetic radiation emitted from the phones.
“In light of the research findings, it is certainly recommended to shorten the duration of calls, not to carry the phone near the groin, not to sleep next to it, not to talk while it is being charged — in fact, it is better to turn it off while it is being charged — and to use a headset or hands-free kit whenever possible,” warned lead author Dr. Ariel Zilberlicht, a gynecologist at Carmel Medical Center and a faculty member at the Technion Faculty of Medicine, both in Haifa.
Zilberlicht and his colleagues stress that further and larger studies are needed to confirm their findings of cellular radiation damage in the context of male infertility.
Male sperm quality, which is steadily declining in Western countries, accounts for 40 percent of infertility problems among couples. Accumulated research knowledge on this subject shows that sperm quality is affected by congenital genetic factors but also by environmental variables — including the growing use of cellphones.
Previous studies looking at a possible connection between sperm quality and the radiation emitted by cellphones have reached varying conclusions because they were carried out under different sets of conditions, such as laboratory experiments on tissue or on animals. Furthermore, most of these studies have not addressed all the relevant variables.
The Haifa study involved 106 men who had been evaluated at Carmel Medical Center’s Fertility and In Vitro Fertilization (IVF) Unit in 2011-2012, and addressed a wide range of variables related to cellphone usage habits and sperm quality according to parameters set by the World Health Organization in 2010.
Participants filled out detailed questionnaires including demographic characteristics and data, medical conditions, and highly detailed and comprehensive questions about their cellphone usage: how much time spent on the phone each day, where the phone is carried, whether calls are made or received in areas with poor reception and while the phone is charging, and others.
After collecting the data, the researchers examined the connection between all the independent variables and sperm-quality results. Their published paper reporting the results is titled “Habits of cell phone usage and sperm quality — does it warrant attention?”
The study was carried out as part of the doctoral work of Dr. Yulia Sheinfeld from the Technion Faculty of Medicine, under the guidance of Technion clinical associate professor Martha Dirnfeld, director of the Fertility and IVF Unit at Carmel Medical Center.
A little more than four years ago, I was walking on Cashio Street and I dropped something on the ground. When I bent down to get it, let’s just say it wasn’t easy to stand back up. I was almost 200 pounds with a big puffy face. I was really starting to feel old.
A day or two later, as I was being introduced to go on stage, Dom Irrera, a comedian friend, said to me, “Look how fat you are.” Soon after that, I was with another friend when he pointed to an old guy using a walker while crossing a street and said, “We don’t want to end up like that.”
OK, message received: Lose weight. So the next day, I decided to crawl out of my fat suit and do something about it. It took a year, but I lost 50 pounds and have kept those 50 pounds off for more than four years. Losing the weight was not hard. It was exciting. But keeping it off is murder. I now exercise seven days a week. That’s good, but the food is where it’s at. I have been an overeater my whole life — still am and always will be. I remember when I was 3 months old being breastfed and my mother screaming at me, “Enough already. Don’t you ever stop eating?” My problem is I’m never full. I could eat a 15-course dinner and on the way home, stop for popcorn and pie á la mode. I have an empty space inside of me that is very demanding and never satisfied.
In order to lose the weight and keep it off, I had to do just one little thing: change just about everything. For me, that means not eating things I used to enjoy and not having them ever again. And doing this one day at a time. I don’t eat pizza, pasta, bread (except on Shabbat) and my dessert is fruit (no more cakes or cookies). To the best of my ability, I’ve given up all sugar. My diet now is whole food, and plant based. I recently talked to my rabbi to see if he could somehow get rid of the 7,000-calorie-a-day holidays such as Passover, Sukkot and Shavuot. They are killers for a person like me.
As I was losing the weight, a funny thing happened. I noticed that my losing weight bothered my Jewish friends more than my non-Jewish friends. Jews get very worried when you lose weight. They all think they are doctors and diagnosticians. They say things like, “Are you OK?” “Why did you lose the weight?” “Did you want to lose the weight?” On the other hand, when my non-Jewish friends would see me, I’d hear, “You look great!” “How’d you do it?” “Bet you feel terrific!” “Want to go to the rodeo?”
A few of my Jewish friends called my wife to try to pry out of her how long I had to live. Sometimes they would walk up to me in the street and scream, “Enough already.” “Stop it.” “Don’t lose any more weight.” The crème de la crème was when I was in Glatt Mart supermarket and this woman I know looked at me, turned white and started running away. I quickly caught up with her and asked if she was all right. She was trembling right there in the middle of the store. She told me she had heard I was very sick and that I had died. And she always liked me and was very sad to get the news of my death. I thanked her for her kind words, told her I was all right and went back to eat some free grapes.
About an hour later, I thought: If she liked me so much, why didn’t she send a card or make a small donation in memory of me? Fooey on her.
A few months later, I was visiting my 85-year-old aunt, who offered me a piece of cake. I said, “I don’t eat cake.” She said, “Life is not worth living without cake.” I guess if I were married to my Uncle Louie like she was, I might feel the same.
One rabbi who wanted to lose weight called and asked me to meet him and tell him how he could do it. I asked, “Where do you want to meet to talk?” He said, “Schwartz Bakery.”
Keeping off the weight is a daily fight. It’s by far the hardest thing I’ve ever done. Everyday I am on the battlefield trying to stay alive. To my Jewish friends, I know you mean well. And when I do die one day while eating a bowl of broccoli, you can all have your laugh. What I’ve come to understand is that all the foods that I thought I could not live without, I hardly ever miss. And as I get older, I realize that almost everything in life is overrated anyway. Keeping off weight is a full-time job. My paycheck is getting my health back and wearing my kids’ clothes.
Mark Schiff is a Jewish comedian, actor and writer living in Los Angeles. He is originally from a very poor and haggard New York Jewish family.
This past week, I was in Miami for the bris (or brit), the Jewish ritual circumcision, of my grandson. It’s a good time to offer a defense of the Jews’ most ancient ritual.
According to various reports, there are Jews — and not only Jews who have forsaken their Jewish identity — who oppose circumcising their sons. They are still a minority, but they are vocal and, I suspect, growing.
Their primary arguments are that circumcisions, whether for religious or medical reasons, are unnecessary; that they are a form of mutilation; and that the act inflicts serious pain on the 8-day-old for no good reason.
Let’s begin with the first objection. In fact, circumcision is both medically and religiously necessary. People are free to object to circumcision, whether performed by a mohel (Jewish ritual circumciser) or a physician. But they need to be honest with the facts.
“The scientific evidence is clear that the benefits outweigh the risks,” Dr. Jonathan Mermin of the Centers for Disease Control and Prevention announced in 2014.
“The benefits of male circumcision have become more and more clear over the last 10 years,” added Dr. Aaron Tobian, a Johns Hopkins University researcher.
Circumcision is so medically beneficial that many African countries demand that their male citizens get circumcised. The reason is that, other than sexual abstention, circumcision is the best way to reduce the risk of contracting AIDS. And there are multiple other health benefits.
Personally, I would endorse the bris even if there were no medical benefits. I only cite these benefits to refute those who argue that circumcision is not beneficial, or is even harmful.
What matters to me are the religious benefits of giving one’s son a bris — or brit milah, “covenant of circumcision,” to give it its full name. They are, of course, not as objectively measurable as medical benefits, but they are even greater.
I found the circumcisions of my two sons and two grandsons more emotionally and spiritually moving than any other religious activity in my life. Here I was, in as dramatic a way as one could imagine, bringing my sons and grandsons into the Jewish people and into the Jewish covenant with God. I thought about how my father had done this to me, and his father to him, going back to Abraham, more than 3,000 years ago. I thought about all the Jews who, at the risk of their lives, brought their sons into the covenant during the many anti-Semitic periods in Jewish history.
As for “mutilation,” that is a complete misuse of the term. The term properly describes what is done in many Muslim societies to the genitalia of young girls. That is why it is called “female genital mutilation.” Its vile purpose is to deprive women of the ability to enjoy sexual intercourse. And its effects are prolonged excruciating pain and permanent physical disfigurement. To compare that to the removal of the foreskin is not only absurd, it trivializes the horror of female genital mutilation.
With regard to pain, of course the baby experiences pain. The question is how much and whether there is any lasting trauma.
The amount of pain is essentially impossible to judge for a number of reasons, however. One reason is that we can’t ask the baby: “What is your level of pain from 1 to 10?” Another is that many babies barely whimper during the brit. Virtually all cry far more loudly and for far more time when they have gas or are hungry — and neither condition is regarded as abnormally painful, let alone traumatic.
Nevertheless, the request of any parent who wants to have lidocaine injected into their baby’s foreskin to numb the pain should be honored. There is no halachic issue here; after all, adult men who undergo a brit can be fully anesthetized.
To assess whether one wants one’s son to undergo a brit milah, one has to recognize one of the most important laws of life: Everything has a price. There is a price paid for having a brit, and there is a price paid for not having one.
The price for having one is momentary pain in an infant. That’s it. The idea that a man pays some lasting price for not having his foreskin is refuted by the experience of virtually every circumcised male who has ever lived. I have only met one man in my life who was troubled about not having his foreskin. On my radio show, I once interviewed a spokesman for an anti-circumcision group based in — you’ll be shocked to learn — San Francisco. And I told him I thought he must be very bored to devote so much of his time to lamenting his lost foreskin.
As opposed to the minuscule price paid for having a brit, there is an enormous price paid for a Jew not having a brit. The advantages wildly outweigh the momentary pain. The brit uniquely strengthens a Jew’s religious identification, and the ceremony instills in the family and in the community present at the ceremony a profound identification with the nearly four millennia of the Jews’ world-changing history.
Dennis Prager’s nationally syndicated radio talk show is heard in Los Angeles from 9 a.m. to noon on KRLA (AM 870). His latest project is the Internet-based Prager University (prageru.com).
A recent study of critical-care physicians at one Southern California hospital system found that more than 1 in 10 patients receiving treatment in their hospitals’ intensive care units were receiving treatments that would not benefit the patient in a meaningful way. These treatments usually would keep a patient alive, albeit briefly for most, but not in a fashion befitting a human. Many of these patients were comatose with no chance of improving, others could never survive outside of an intensive care unit, but medical technology with tubes and drips and endless effort could keep them precariously balanced between life and death in a room full of machines. The physicians surveyed in this study, many deeply wounded by the experience, indicated that they should not be providing these critical-care treatments. But they were compelled to do so by families who could not let go, families who were willing to preserve life for an extra day or several despite the state of their loved one, the suffering and the cost.
In the recent parsha V’zot ha-Brakhah, we read about the farewell blessing of Moses to the Israelites. At 120 years of age, Moses views the land that God promised to Abraham and his descendents. The Israelites will proceed to inhabit this land of milk and honey, but Moses will not. Moses must die in the land of Moab just short of leading his people into the promised land. Moses died “al pi Adonai,” meaning that Moses died “at the command of the Lord.”
The rabbis examined why Moses required the Lord’s command to die. In the words of Elie Wiesel, retelling the rabbis’ analysis, “When Moses learned that his hour had come, he refused to accept it. He wanted to go on living — though he was old and tired of wandering and fighting and being constantly tormented by this unhappy and flighty people he was leading across the desert.” According to the rabbis, Moses then haggled with God to continue to live, composing prayers, putting on sack cloth, calling on others for support and arguing “Don’t you trust me? … Have I not proven my worth?” God would not back down. Wiesel notes that after being advised by an angel to accept God’s decree, Moses should have graciously heeded the sage advice. But Moses would not and he began to bargain according to Wiesel:
“He went on refusing to die, pleading, crying for another day, another hour, as would any common mortal. … So great was his despair that he declared himself ready to renounce his human condition in exchange for a few more days of life: ‘Master of the Universe,’ he implored, ‘let me live like an animal who feeds on grass, who drinks spring water and is content to watch the days come and go.’ God refused. Man is not an animal; he must live as a human or not at all.”
The rabbis understood humans’ unwillingness to give up life. But they also understood that all humans must die. The struggle to survive is innate in each of us, yet we need to learn that this strong impulse must accede to a greater force. The rabbis recognized that humans would be willing to trade one’s most precious attribute, humanity, to prolong life, if even for a brief time. They projected that even Moses, the powerful and great leader of the Israelites, would be willing to give up cognizance of the nature of the world, recognizing others and being part of the human race just to eke out another day.
The rabbis never could have imagined this battle playing itself out daily in intensive care units around the globe, as the study shows. Man, imbued with the divine spirit, has developed medical advancements that rescue those with failing hearts, lungs, bowels and livers. People who have experienced “sudden death” are hurriedly hooked up to blood-pumping, oxygenating, continuously detoxifying, remarkable machines by amazing clinicians. Some of these people miraculously walk out of the hospital to continue a renewed life. But for many, these ventilators, artificial hearts and kidney machines cannot restore humanity. Instead, these machines and feeding tubes and medications yield broken bodies that cannot interact, cannot swallow or taste, cannot recognize loved ones. Many suffer while being maintained alive.
The rabbis, nearly two millennia ago, when herbs and leeches constituted the best medical care had to offer, recognized that man was not served by succumbing to the basic instinct to preserve life at any cost. We can learn today that it is humanity we must strive to preserve at all times. And that there is sometimes a need to say, “No, it is time to die.”
Dr. Neil S. Wenger is professor of medicine in the Division of General Internal Medicine at UCLA and a consulting researcher at RAND. He is director of the UCLA Healthcare Ethics Center and is chair of the Ethics Committee at the UCLA Medical Center.
This article originally appeared on The Media Line.
[Jerusalem] Scientists at Jerusalem’s Hebrew University have announced the creation of an internet tool that they hope will be a step forward in tackling illnesses associated with mutated genes passed from parents to children. A number of cancers, such as ovarian and breast cancer, are more likely to occur in people carrying genes that can be prone to mutation.
Scientists are able to identify how certain human genes correspond with specific traits in a person, such as blue eyes or a propensity towards breast cancer, but have yet to map out the entire network of correlations. By examining the evolution of a variety of animal species scientists were able to identify correlations between specific traits and their corresponding genes.
“The idea is very simple – what we are looking at is a very interesting pattern across evolution,” Dr. Yuval Tabach, a researcher from the Institute for Medical Research Israel-Canada at the university’s Faculty of Medicine, told The Media Line. Through study of species that had once possessed a certain quality and then lost it, such as vision in moles or cave fish, the researchers identified gene patterns.
Using this research Tabach’s team developed an internet tool which they hope will allow doctors or scientists to investigate the properties of a gene “according to its evolutionary profile.” In theory, anybody would be able to go online and use the application, with “the push of a button,” Tabach said, though the scientist did admit that interpreting all of the output information might take some understanding.
The significance of identifying gene properties was highlighted in 2013 when actress Angelina Jolie underwent a double mastectomy after discovering she had inherited a gene mutation from her mother which increased the risk of ovarian and breast cancer. Her mother had died of the disease at 56.
In Israel the section of the population carrying gene mutations which increase their risk of breast and ovarian cancer stands at 2.5%, compared to the global average of 1%, Miri Ziv, CEO of the Israel Cancer Association, told The Media Line. In part this is due to a higher risk of carrying mutated genes among people with origins in Jewish Iraqi and Ashkenazi communities. Such is the increased risk that the National Health Service of the United Kingdom places Ashkenazi women – Jews with origins in Eastern Europe – in its high risk category for breast cancer, Ziv said. There are moves to do the same thing in Israel with increased screening for Ashkenazi and Iraqi women, the CEO added.
Like Jolie, any women who has relatives who suffered from breast cancer or who had themselves been diagnosed with the disease is recommended to seek a medical consultation to identify whether they carry the mutated gene. The genetic trait can be passed down via the father’s bloodline, not just the mother’s.
Israel bears the unique difficulty of dealing with the children and grandchildren of families who came through the Holocaust, Ziv said. They often don’t know their family histories.
But of those diagnosed with breast cancer only 10% carry the genetic marker – the remaining 90% have contracted the disease due to some other reason. This means that all women should be aware of the risks, Ziv said.
The Salinas Valley is world famous for producing healthful foods, but people here struggle with severe health challenges. As a physician seeing patients in exam rooms, I found it enormously difficult to help people—even those harvesting lettuce—to eat in healthy ways.
I decided to try a new approach—educating people before they develop serious health problems. That has meant offering five-week-long classes to groups of people in migrant education offices, school districts, low-income housing sites, senior centers, Head Starts, offices for CalWorks (the State’s aid program for needy families), and a farm labor camp.
We’re seeing such strong results—we’ve reached more than 400 people eager to prevent diabetes in the Salinas Valley—that we’re planning to offer more classes, in more places.
These classes are the product of my nearly 40 years of work here. I moved to Monterey County in 1976, from New York via Delano in the San Joaquin Valley, to work for the United Farm Workers. In 1980, I launched a career in health care, first as a nurse’s aide and then a nurse before I went to medical school and became a doctor. I returned to Salinas to do my residency training at Natividad Medical Center.
I love the Salinas area. Its physical beauty is striking, and it enjoys a rich diversity of cultures. Monterey County is more than half Latino—from recently arrived, indigenous language-speaking Oaxacan immigrants to U.S.-born Latinos—and includes communities like Seaside and Marina, with African-American, Vietnamese, Korean, Asian and Pacific Islander, and other populations, making the area feel like a microcosm of California. It’s been gratifying to see the local power structure change to represent the diversity of the communities. Salinas is a city, but it’s not so big as to be overwhelming. As John Steinbeck wrote in 1955, there’s “Always Something to Do in Salinas.”
In some ways, Salinas is quite healthy. The most recent major health assessment by the Monterey County Health Department found some good news: decreased smoking rates, big declines in deaths from stroke and heart disease, and decreased overall mortality rates from diabetes. But the assessment also found large health disparities between Latinos and non-Hispanic whites covering everything from cancer screening to teen pregnancy to diabetes mortality and obesity.
These disparities had long bothered me personally, because I saw them in the exam room. I’ve devoted my career to public sector health care; my hospital, Natividad Medical Center, is one of just 21 public health care systems in the state. As a family physician, it was frustrating to realize that my curative work was often too little, too late. I was seeing obesity and diabetes at younger and younger ages; it was becoming an epidemic here, and Monterey County already had higher rates of diabetes than the state average. It was clear that people, particularly in the Latino population, needed earlier intervention and more robust education about their health.
So I decided five years ago to make the transition from seeing individual patients to focusing on public health, via Natividad’s foundation.
At first, I wasn’t quite sure how I wanted to work on prevention. I discovered quickly that for all the talk about prevention, there wasn’t much funding for it. One of the first things that got knocked out of the bill that became the Affordable Care Act was a sizeable part of prevention funding. And usually funders want to see quick results; that’s hard with prevention programs, since the outcome, if it’s good, is something that didn’t happen.
I started with a vision of a health promotion center. But I soon focused on a crucial aspect of health promotion: the prevention of diabetes. I had been struck by groundbreaking research from the National Institutes of Health and the Centers for Disease Control and Prevention that showed how simple measures—like walking 30 minutes a day and losing only 5 to 7 percent of body weight—could prevent diabetes in people with pre-diabetes. Indeed, measures like this outperformed a widely used diabetes medication.
I also knew we had to get out to communities, to communicate with people in familiar groups and settings. Our local community foundation—the Community Foundation for Monterey County—backed a program that we called “Five Steps to Prevent Diabetes,” and in fall 2012, we began the classes. They run once a week for two hours at a time, for a total of five weeks, at convenient times. During the harvesting season, scheduling can be tricky, so we try to offer many during the winter off-season. We also offer classes right after work, from 6 to 8 p.m.
Each class has a different topic—diet, physical activity, portions, diabetes—and we give homework that consists of exercises such as keeping a calendar of how many of cups of fruit and vegetables one eats in a day. People then share their progress—and obstacles—with the class and offer insights and solutions to each other, a strategy we’ve found to be especially powerful. We conduct the classes in English or Spanish, and we don’t use Power Points. Instead, we get people up and moving; they create model plates of food, they stretch resistance bands, and they jump rope. Seniors can participate in modified physical activities, such as chair exercises.
The idea is to teach easy and affordable strategies that people can use at home. We conduct testing of the participants before and after to evaluate progress. (We use validated United States Department of Agriculture and University of California, Davis questionnaires that are linguistically and literacy-appropriate). Starting with the first year of the class, we’ve seen significant improvement on most (and for the last two years, all) of the 13 measures we use, which include daily quantities of vegetables and fruits eaten and other behavior changes.
Over three years, we’ve modified the curriculum slightly to make concepts simpler, navigating some literacy challenges along the way. And we’ve seen—particularly in the case of a mother in our classes whose five-year-old child weighed over 100 pounds—how getting a whole family to improve its health together is crucial to making progress. (The mother reported the child was doing better, in conjunction with appropriate medical care.)
It’s important to recognize that change takes time. A young mother whose husband was diagnosed with diabetes reported that it took a year to make changes in the family diet that stuck. Eventually, though, the whole family was eating more healthfully, even eating tacos with lettuce-leaf wraps instead of tortillas.
I’ve been struck by just how avidly people want this information. Obesity and diabetes, which are often connected, have touched so many in this area that people are truly frightened by them. All of our class participants know someone with diabetes, and several report having family members with diabetes-caused amputations, blindness, neuropathy, and death. Families want what is best for their children and as a result are hugely motivated to keep the next generation healthy.
We just received funding for a fourth year for “Five Steps to Prevent Diabetes” from the community foundation, so we’re reaching out to new partners and trying to take the classes to other parts of the county and the Salinas Valley, such as King City. We’d also like to offer more in the indigenous languages that many workers in Monterey County speak; Natividad Medical Foundation has as project to teach indigenous language speakers to become interpreters who can work in health care, the courts, at the DMV, or in other settings.
We’re also learning how to encourage people to eat more of what is grown here. Part of the problem is price, since locally grown artichokes, berries, and exotic vegetables are often expensive. And many Salinas residents, because they’re familiar with agriculture, are very conscious about pesticides. In our classes at various food banks, food bank staff members told us that when they would send people home with free local produce, the recipients would sometimes throw it out if the fruits or vegetables were unfamiliar to them.
We discovered that many people don’t know what to do with some of the produce they and their neighbors help grow; they’re not used to having it in their diets in their countries of origin. But if you give them recipes or provide a cooking demonstration, they’re likely to use the produce. We conduct simple food demonstrations and give participants recipe cards.
We’ve been inspired to hear our participants’ reports. One Head Start mother from King City started her own vegetable and fruit garden. Several women at a labor camp in Soledad started a walking group, circling the expansive agricultural fields together at dusk. Another participant switched from white rice to brown rice or quinoa. Another substituted nopales for tortillas. Several tried recipes for baking instead of frying enchiladas or chicken. Others added more tomatoes, onions, and peppers to soups to increase their young children’s vegetable consumption. People love recipes for good local food; they know the goal is healthy living.
In the Salinas Valley, investment in prevention is paying off. And we’re confident that an even broader community health is attainable here.
Dana Kent is a family physician working in Salinas, California, with the Natividad Medical Foundation, which supports Natividad Medical Center. This essay is part of Salinas: California's Richest Poor City, a special project of Zócalo Public Square and the California Wellness Foundation.
No need to spend money on a pricey gym membership or state-of-the-art home equipment — you can get a full-body workout for less than $35. With free online workout videos and reimagined childhood toys like Hula-Hoops and Frisbees, fitness can be affordable, portable and fun.
Picture the last time you went for a walk: You may have negotiated uneven pavement, or stepped from grass onto a dirt trail, adjusting to the differences in terrain without much thought.
People with some walking disorders don’t have that ability, but an Israeli-designed invention may help them regain it.
The Re-Step system uses specially designed shoes to simulate the unpredictability of real-life walking in the controlled setting of the rehab clinic. It signals a novel approach to the treatment of walking difficulties caused by cerebral palsy, stroke or other brain trauma, as well as balance problems that can come with age.
Simona Bar-Haim conceived the idea after a chance conversation introduced her to the idea of chaos theory. This theory says that seemingly unpredictable, complex systems often turn out to have patterns. Bar-Haim, at the time a physical therapist with a master’s degree in neurophysiology, suspected that chaos theory could apply to the mechanics of walking and balance.
“Many systems in nature … and our bodies work like a chaotic system,” said Bar-Haim, who now has a doctorate and heads the Laboratory for Rehabilitation and Motor Control of Walking at Ben-Gurion University of the Negev.
Our heart rate, for example, varies from moment to moment based on the environment and other factors. So does our walking. But brain damage and age can interfere with this adaptability.
“I thought maybe we could restore this flexibility to the damaged brain,” Bar-Haim said.
She teamed with physiologist Mark Belokopytov to develop the Re-Step training technology, which uses unique footwear to help users learn (or relearn) to walk.
The shoes, which weigh about a pound and a half, look like platform high tops with knobs on the bottom. The knobs house small pistons that subtly change height and angle as directed by a customized computer program. Minute movements make the user feel as if he or she is walking on an uneven surface. (One wearer compared it to walking on small potholes.) Sensors on the shoes measure properties of the wearer’s gait, such as speed and symmetry.
The Re-Step program typically involves 22 training sessions of 50 minutes each, supervised by a physical therapist trained to use the system. As the user gains ability, the system increases in difficulty.
Wearers cannot rely on what they see because they have the sensation of walking on uneven terrain even as they walk on a flat surface. They must compensate for this discrepancy by using balance. The idea is that as the brain responds to the perceived changes, it learns how to walk and balance.
“Traditional physical therapy and rehabilitation of walking is based on knowledge from the mid-20th century that believes … the goal is to be ‘normal’ again,” Bar-Haim said. “But the new trend in 21st-century neuroscience [supports] inducing error into rehabilitation training. … Ours is the first technology to put this theory into practice.”
Bar-Haim and her colleague, Belokopytov, along with Israeli health care industry professional Jacob Witkowski, launched the company Step of Mind around 2006 to develop and distribute the Re-Step system. There is one Re-Step clinic in Tel Aviv, located on the campus of Reuth Medical Center, and three in Turkey. Bar-Haim said Step of Mind is in advanced negotiations with Chinese venture capitalists interested in opening clinics in that country.
In 2014, Bar-Haim participated in the Newport Beach-based Merage Institute’s Innovation Bridge Business Leadership program. This two-week seminar helps teach Israeli entrepreneurs how to conduct business in the United States. Thus far, however, Step of Mind has not been able to secure the funding and support necessary to obtain Food and Drug Administration approval and enter the U.S. market.
Dr. Mindy Aisen, chief medical officer at Rancho Los Amigos National Rehabilitation Center in Downey, said she would welcome the opportunity to test the Re-Step system at her facility. Aisen met Bar-Haim when she was CEO of the Cerebral Palsy International Research Foundation. She served on the scientific advisory committee for some of Bar-Haim’s early research and has continued to follow her efforts.
“She’s done very clean scientific work, taking an idea from theoretical to literally on the feet,” Aisen said. “There is nothing like this currently available, and my hypothesis is that it would be a valuable addition to our toolbox.”
At Ben-Gurion University — which this writer visited during a trip sponsored by the American Associates, Ben-Gurion University of the Negev — Bar-Haim has received a major grant from the Israel Insurance Association for a three-year study to investigate how the Re-Step system can help individuals who have suffered traumatic brain injury in a car accident.
Bar-Haim believes the field of physical therapy is on the cusp of nothing less than a revolution thanks to the introduction of technology.
“Technology and robotics can induce an artificial environment that manual therapy cannot,” she said. “Technology also provides accurate, objective information and data that we couldn’t receive in the past.”
As someone who began her career as a physical therapist and has devoted it to helping people regain mobility, Bar-Haim gets particular satisfaction from the results she has seen.
“Mobility means freedom and autonomy for everyone — including persons with disabilities,” she said. “We are proud to develop [a way to restore] the freedom of walking to those who lost it.”
Why take Max Izenberg’s advice on what’s going on around town? Because the retired nutritionist knows what’s good for you.
Izenberg built her career on helping people and being well-informed, qualities she’s found useful in gathering and sharing information with an extended community of Los Angeles-area seniors through Suddenly 65, her weekly online newsletter.
“While there are many sites for seniors, nobody is doing what I do in terms of the different kinds of information offered,” Izenberg said. “Furthermore, the senior sites I came across were written for a national audience and often heavily consist of links to other senior-oriented sites. My newsletter differs in that it is custom-designed for the local L.A. audience, so the readers have specific, accessible resources and activities at their fingertips.”
The San Fernando Valley resident’s dose of events, health tips and consumer information (such as warnings against online scams directed at seniors) is sent every Thursday by subscription to nearly 6,000 people. New subscribers coming to Suddenly65.com are greeted with a video of the energetic 70-something explaining how to sign up for a subscription for access to the latest happenings for seniors, especially in the area between Burbank and Thousand Oaks.
“My mantra is that we cannot help getting older, but we don’t have to be ‘old,’ ” Izenberg said as she contemplated her second career, launched in February 2012 with her first online newsletter. It was an instant success, winning the Los Angeles Daily News’ Readers’ Choice award two years running for favorite boomer/senior newsletter.
“If you’re sitting at home doing nothing, you are going to get old,” Izenberg continued. “Without any social interaction, the experience of aging can be terrible. Boomers and seniors want to get out because they are vital, healthy and naturally curious about life. Sometimes, all they need to do is find out what’s happening in their backyard. What my newsletter does is help them do just that when planning ahead for the weekend or the following week.”
The New Jersey native raised four children in the Valley and spent a dozen years in Las Vegas with her husband of 58 years, Jerry, before returning to the area and finding her social landscape drastically changed. A number of old friends had died or moved away. Although it seemed like a simple Internet search should help the active couple connect with new friends and find enlightening activities, they found the Web remarkably lacking in “Meet Up”-type groups and social networking for people over 50.
“When I Googled ‘social resources for seniors,’ I found nursing homes,” Izenberg recalled, surprise still resonating in her voice. “When I had gotten in touch with friends still living in the area, they told me they were also having a hard time finding interesting things to do. As returning long-term Los Angeles residents, we knew there had to be things out there for us.”
After pondering the situation for two months, Izenberg came up with the idea of starting a newsletter for boomers and seniors filled with leads to events and useful information. Since then, she’s found that the process of putting the letter together, with support and feedback from Jerry and her readers, keeps her “feeling as if I’m still in my 20s.”
Although she regularly gets tips from readers, she also exhaustively researches everything going on in communities throughout Los Angeles, from music performances to free movie screenings, live theater, dancing clubs and classes, and various activities staged at libraries, community centers and other public venues. She also networks with neighborhood councils, chambers of commerce and fellow members of JNET, a Jewish professional networking organization, to uncover leads. Izenberg even does some in-the-field research.
“When I first started the newsletter, I got a tip about the San Fernando Valley Symphony Orchestra having something going on at Canoga Park Bowl [a bowling alley now known as Winnetka Bowl],” she said. “It sounded strange at first, so I told my husband we should check it out before putting it in the newsletter. It turned out to be one of the most fun evenings we ever had. James Domine, a music professor at Pierce College and San Fernando Valley Symphony Orchestra’s music director, had a band performing at Canoga Park Bowl. We went, and the entire audience was people our age. This is exactly the kind of thing my readers are looking for.”
Her other criteria for inclusion in Suddenly 65 are that events be open to the whole public — in other words, grandchildren — and have low or no cost of admission. She recently added a list of museums in greater Los Angeles with free admission; some theaters and venues even offer Suddenly 65 readers discounts on tickets and admission.
Izenberg’s goal is to help subscribers make the most of what’s going on in their community.
“My readers are learning, for example, that a library is more than just a place to [borrow] a book, through the wonderful activities scheduled, such as lectures, computer-education classes and live performances,” she said.
“Suddenly65.com is a valuable tool for our readers, not just for a better daily life, but also for situations like finding memorable places to take friends and family coming into town. The sky is the limit for my readers — all we need to do is put it in front of them.”
When her son Calvin was diagnosed with Pitt-Hopkins syndrome (PTHS), a rare genetic disorder characterized by delayed physical development and severe mental retardation that has been identified in only about 300 people worldwide, Audrey Davidow Lapidus knew she had a choice: Succumb to despair or make a difference. She chose the latter.
Less than three years later, the Lapidus family’s efforts have, according to the leading researcher in the field, helped “accomplish nothing short of amazing.”
Audrey and her husband, Eric Lapidus, welcomed Calvin, their second child, in February 2011 — a baby boy with a full head of dark hair and an unusually large nose.
All seemed fine initially. But as the months progressed, Calvin failed to reach expected developmental milestones. He didn’t roll over. He didn’t crawl. The couple knew something wasn’t right. Audrey Googled “large nose and developmental delays.”
“Everything came up,” she said. “I started freaking out.”
The West Hollywood couple took their son to a phalanx of doctors — pediatricians, geneticists and neurologists — but none of them could find a problem. One neurologist told them, “He’s fine. Call me when he graduates Harvard.”
But Calvin wasn’t fine. The fourth neurologist suspected Calvin might have a rare genetic disorder. A newly developed genetic test revealed that Calvin had PTHS, an alteration in one of the genes of the 18th chromosome.
An autism spectrum disorder, PTHS is characterized by moderate to severe intellectual disabilities; difficulty with walking and balance; breathing abnormalities; seizures and an inability to speak. Life expectancy is unknown as most of those who have been diagnosed are young children. There is no known racial or ethnic link.
Three years before Calvin was diagnosed, Theresa Pauca received the same devastating news about her son, Victor. The North Carolina mother searched the Internet, desperate to connect with another Pitt-Hopkins parent. Finally, she found a mother in the Netherlands who had posted on a message board of the National Organization for Rare Diseases. The two formed a Google Group to connect Pitt-Hopkins families, and eventually they and other families created the Pitt Hopkins Research Foundation. Through fundraising efforts including simultaneous 10Ks runs, the group raised about $30,000 over the course of three years.
When Audrey initially Googled Pitt-Hopkins and discovered Pauca and the foundation, she and Eric were relieved to find a community.
“It’s the last club you want to be a part of, but you’re desperate to be a part of the club,” said Eric, a television writer and producer. “Every special-needs family I’ve spoken to says that part of their life, they just don’t feel seen or heard or understood. Opening yourself up to a community of other families is the one place where you can feel understood and that you’re not alone.”
At the same time, the Lapiduses were dismayed at how little research focused on their son’s condition. Audrey, a former journalist and editor with Los Angeles Magazine and Angeleno Magazine, put her investigative skills to work. She found Dr. David Sweatt, a neurobiologist at the University of Alabama, Birmingham (UAB) School of Medicine, whose research involves how molecular mechanisms regulate learning, memory, language development and other brain functions. Audrey sent Sweatt an email asking him to consider doing research on Pitt-Hopkins, and promising to raise funds to support such efforts.
“PTHS is such a rare disorder that I had never even heard of it before,” recalled Sweatt, director of the McKnight Brain Institute at UAB.
He was intrigued by the disease and felt a moral obligation to explore it.
“Every human should have an equal opportunity for hope for a better life,” he said. “No one was working on it. It was in my area of expertise. … I felt I had a chance of doing some good.”
Calvin and his sister, Sadie.
Sweatt told Audrey she would need to raise about a million dollars to advance Pitt-Hopkins research sufficiently that federal funding agencies might take interest. Audrey promptly penned a fundraising appeal that the couple and their extended family members posted on Facebook and sent to everyone they knew.
Eric’s Hollywood connections helped. So did Audrey’s father, Jeffrey Davidow, a former ambassador to several countries, including Mexico. He helped secure some corporate contributions, including $30,000 from tequila-maker Jose Cuervo. Even Calvin’s older sister, Sadie, now 8, joined the fundraising action, holding bake sales, manning a lemonade stand and selling bracelets.
Within their first year of joining the Pitt-Hopkins community, the Lapidus family raised about $300,000 — 10 times what the foundation had raised up to that point.
Last year, the foundation awarded $320,000 in grants to researchers at four institutions, including Johns Hopkins and Massachusetts Institute of Technology (MIT). Another two researchers received grants of $55,000 each through the University of Pennsylvania’s Million Dollar Bike Ride, which raises funds for rare diseases.
And in July of last year, Sweatt received a $1.8 million, five-year grant from the National Institute of Mental Health to investigate the molecular and neural basis of PTHS.
“To my knowledge, it is the first research grant on Pitt-Hopkins syndrome ever to be funded by the [National Institute of Health], the major funder of biomedical research in the U.S.,” Sweatt said. “It simply wouldn’t have been possible for us to get this funding without the hard work and support of the PTHS Foundation group and the Lapidus family specifically.”
Audrey now serves as the president of the volunteer-run foundation. She helped organize the first PTHS symposium, held at MIT last September and attracting more than 40 researchers.
“It’s important that scientists be collaborative,” she said. “Some met a Pitt-Hopkins kid for the first time. They saw what they were fighting for and why we need them to work together.”
As the couple talked about all this outside on their front porch, Calvin, now 4, was inside having a session with an applied behavioral therapist. Animated and still displaying the thick, dark hair he boasted at birth, Calvin has some type of therapy — including physical, speech and occupational — every day of the week. He can understand what others say to him but cannot communicate with more than sounds, gestures or by using augmentative and alternative communication applications on an iPad.
Audrey remains hopeful about the outlook for her son because PTHS does not seem to involve structural or anatomical damage to the brain. Rather, it is a disruption of signaling in the brain. So theoretically, the signaling might somehow be restored.
“It’s in there,” Audrey says, referring to her son’s latent abilities. “How am I going to get it out?”
I grew up with my younger brother, Zack Thomas, who has struggled with bipolar disorder since he was a very young child.
What it has taught me is that as individuals, and as a community, encountering mental illness is a blessing and a challenge — and one that we need to do a much better job of talking about.
I say blessing because I am who I am today because of the empathy, humility and strength that my experiences have cultivated within me. I say challenge because struggling with mortality, whether of the mind, body or soul, is perhaps the greatest challenge we know in this life. Mental illness exists in my nuclear and extended family, as well as among many of my close friends, two of whom tragically committed suicide during my high school and college years. I hold their memory in my heart today.
There is a brokenness that reaches into our hearts and our minds. A brokenness that causes alienation and disrupts our plans and our dreams. It is a brokenness that breeds loneliness, guilt, despair and anger. I am speaking of the brokenness that comes from the suffering and stigma of mental illness, a brokenness I have known in my personal and professional life.
As Zack’s sibling, I learned how to differentiate between my brother and his disorder. I learned that empathy and forgiveness, instead of anger, fear and blame, are crucial in speaking with someone who struggles with manic highs and lows. For much of my life, I have lived in terror, trying to prepare myself for the worst, while still trying to live as though everything is “fine” and “normal.” I have tiptoed, compensated and shed many tears. I am familiar with what Rebbe Nachman poignantly names “יונפה ללח,” (hallal hapanui) an emptiness that arises in the face of suffering. I have learned and continued to learn that mental illness for many is a wave, ebbing and flowing, with good days, better days, bad days and worse days, and that healing is a matter of perspective.
But I have also learned kindness from my brother, Zack. I have learned sensitivity from his Betzalel-like artistic talents and his literary brilliance. I have learned love from his willingness to greet and accept anyone he meets. My brother, who as a child always gave away his toys to his friends, quite clearly embodies what the Torah describes as the בל בידנ (nadiv lev) and בל תמכח (hachmat lev), the generous heart and wise heart. My brother is my role model in living both in his brokenness and in his wholeness.
Today the Los Angeles County Department of Mental Health estimates that one in four Americans has a diagnosable mental illness. One in four people in our families. That is an astounding figure, especially given how much stigma exists around mental illness and how little psychiatric care and psychological care we seek out as a country. Mental illness does not affect “other people,” “them” or “the disenfranchised.” Mental illness affects everyone, and has no boundaries or awareness of financial, religious or cultural differences.
Diagnosable disorders include but are not limited to anxiety disorders, mood disorders, schizophrenia and psychotic disorders, dementias, intellectual disabilities and eating disorders. Many of these diagnoses also have a high comorbidity with addiction and substance abuse. And some tragically include suicidal ideation. Although suicide is a much larger topic, I want to mention that statistically, those who attempt suicide do not want to die, but instead want to stop their pain. These are disorders with which many of us live and, perhaps despite of or even because of, have deeply meaningful lives.
My prayer is that we will begin a conversation that will continue to evolve. We must educate ourselves about mental illness to reduce stigma and create a safe space, and to empower us in providing support to each other. In seeking to better understand and empathize with those living with mental illness, we have the ability as a community to decrease the suffering and shame that come from stigma and to even encourage comfort and dignity. For example, when we say the misheberach, the prayer for the sick, we can pray for a friend fighting cancer or heart disease as well as for a friend struggling with depression or anorexia. Or we may be able to sit with a mother or father who is worrying and praying for normalcy in the face of a child’s recent mental-illness diagnosis.
On the other hand, given how stigmatized mental illness is, it is crucial to respect and honor others’ privacy and boundaries, as we are not always ready or in need of sharing our suffering publicly. Even the language of “mental illness” and “disorder” can feel like labels that alienate and isolate. I encourage us to be creative and rethink our language with informed empathy.
In the Gemara, Masechet Bava Batra 14b, we learn that the ark in the Temple contained both the first set of broken tablets, תוחול (luhot), and the second set of whole tablets. Why do we keep the broken tablets? We have all experienced brokenness, we have all known fragility, and it is not something about which to feel ashamed. It is an inevitable part of being human. We do not seek it out. Yet through our breaks, cracks and fissures, we have the opportunity to allow more light in. At times, our brokenness is part of our wholeness.
As a chaplain specializing in psychiatric care and suicidal ideation, I have learned this Gemara of the broken and whole tablets with patients of varying cultures, backgrounds and faiths, and it resonates. Each time, the same themes arise: guilt at having broken the tablets in our own lives, anger at ourselves and others for that brokenness, pain and longing in learning how to forgive ourselves, and comfort in knowing that brokenness and wholeness can coexist.
God does not ask us to be “fixed,” but instead to recognize all of the raw, broken parts of ourselves. The ark, the center of God’s holy home, holds our broken selves and whole selves. We need the presence of the broken tablets to remind us to be patient when we are fragile and to help us value and not shy away from the shared human experience of brokenness.
Alissa Thomas-Newborn is the Kehilla intern at B’nai David-Judea Congregation. She is also a chaplain specializing in palliative care, end-of-life care and psychiatric care. She is a writer for Metropolitan Jewish Health System’s Center for Jewish End of Life Care. Thomas-Newborn is completing her final year of studies at Yeshivat Maharat.
Can’t fall asleep? Not getting enough sleep? You’re not alone, and that sleep deprivation may be causing a lot more damage than you realize.
Waking up earlier, going to bed later and getting far less sleep than our bodies require not only makes us tired and unable to function, it makes us vulnerable to disease. Sleep deprivation is a serious public safety issue, too: Drowsy driving causes nearly 1,000 fatal car crashes each year.
This epidemic of overtiredness only gets worse as we get older, according to Matthew Walker, director of the Sleep and Neuroimaging Laboratory at UC Berkeley, who appears in the new documentary “Sleepless in America.” The special premieres Nov. 30 on the National Geographic Channel.
“The prevalence of insomnia increases significantly with age. Estimates suggest that at least 40 percent of the adult population over the age of 60 suffers from insomnia,” Walker told the Journal. “The strength of the 24-hour biological rhythm within the brain that helps regulate our sleep/wake cycle degrades as we get older, leading to problems with sleep at night. And the brain regions that help generate sleep, especially deep sleep, are the same that deteriorate most dramatically as we get older.”
It doesn’t help that older adults tend to have more physical pain, which can cause them to wake up throughout the night. They also need to get up to go to the bathroom more frequently, after which they can have a harder time falling asleep, he added.
Walker pointed out that it is “a common misconception that older people need less sleep. Older adults need sleep just as much as adults at other stages in life but cannot initiate or maintain sleep as effectively.”
Studies have established links between sleep deprivation and a host of serious conditions, including cancer, obesity, diabetes, hypertension, heart disease, stroke, Alzheimer’s disease, anxiety and depression. Another concern is sleep apnea, infrequent or cessation of breathing during sleep.
“Apnea fragments sleep, further decreasing the amount of deep sleep obtained,” Walker said, adding that certain other conditions can contribute to insomnia. “Chronic pain can fragment all types of sleep throughout the night. Depression can lead to abnormal sleep, including too much REM [rapid eye movement] sleep and a reduction in deep [non-REM] sleep.”
And there’s more bad news: As “Sleepless in America” explains, cancer researcher Dr. David Gozal of the University of Chicago established that poor sleep may double the speed of cancer growth.
The warnings are clear, but this wakeup call comes with solutions. Mark Rosekind, a fatigue expert with the National Transportation Safety Board, who has been involved in investigating accidents caused by drowsy driving and who appears in the TV special, offered some simple, practical advice.
“Give yourself enough time to sleep,” he told the Journal. ”Have a regular bedtime and, especially, [a regular] wake time. Control your environment: temperature, noise, light. Cooler is better than warmer — 67 to 68 degrees is the perfect sleeping temperature for most people. Anything from earplugs to noise machines can be helpful. Have enough light that you can get around if you have to get up during the night, but not so much that it tricks your internal clock.
“Take the technology out of the bedroom. Not only can it be overstimulating, the light can literally change your sleep patterns as well. You can read, watch television or listen to music in bed. You just don’t want to do something that’s going to get you engaged and stimulated,” he said. So instead of watching something scary that will get your heart racing, stick to reading the tax code, he joked.
Rosekind recommends establishing regular habits and routines that train your body to prepare for sleep, and developing both physical and mental relaxation skills. “The No. 1 cause of insomnia is worrying about something. Yoga stretching, and relaxing and tensing muscles can help, and so can counting sheep, giving yourself something to focus on other than the worry in your head.”
It may help to make a written list of your worries and concerns and what you plan to do about them before you go to your bedroom, Rosekind said. “Then, when you’re in bed and something on the list comes up, you can say it’s on the list and get back to the relaxation skills.”
His No. 1 piece of advice, however, can be the most difficult to follow, given the hectic lives so many of us lead: “Make sure to give yourself enough time for sleep, at least eight hours.”
If shut-eye still remains elusive, Walker suggests seeking out a sleep specialist “who can properly assess, diagnose and treat specific sleep disorders.” Snorers who keep their partners awake would also benefit from this help, he added.
“Snoring is potentially indicative of sleep apnea, which is treatable, and the bed partner will also benefit markedly with treatments,” he said.
The message of “Sleepless in America” is clear, and it’s one that Walker echoes.
“There doesn’t seem to be one major organ within the body, or process within the brain, that isn’t optimally enhanced by sleep — and detrimentally impaired when we don’t get enough. Sleep appears to be the third pillar of good health, together with diet and exercise,” he said. “The single most effective thing we can do each and every day to restore both brain and body health is sleep.”
What does Judaism have to do with healing? This was the topic of the lively conference, “Healing: The Interplay of Religion and Science,” October 26 and 27, 2014 at Arizona State University. Three local attendees were Rabbi Elliot Dorff, Rector and Distinguished Professor of Philosophy at American Jewish University, myself from The Lippman Center for Optimal Health and Neil Wenger, MD Chair of the Ethics Committee at UCLA Medical Center and Director of its Center on Ethics.
Rabbi Dorff described Judaism's emphasis on maintaining our health and the various community resources that contribute to assisting people in that endeavor. The emphasis on addressing the whole individual, not just a symptom or an organ system, carried through the entire conference.
I discussed the similarities between alternative medicine and Judaism. Drawing upon some of the resources Rabbi Dorff described, as well as his writings, I noted that taking a proactive approach to our health and asking questions are two commonalities. Additionally, I showed how keeping ourselves as healthy as possible facilitates our vitality as well as easing our ability to connect to God, a particularly important topic during the High Holy Days. It is easier to change our habits and to improve ourselves when we feel better.
Dr. Wenger's summation of research on religiosity and health was enlightening. Scientific studies reveal that those who are more religious tend to live longer than the general population. On the other hand, praying for the health of another, while it might benefit the person doing the praying, does not seem to improve the outcome for the ill individual.
Throughout the two days, the importance of empathy by the health practitioner became one of the most desirable characteristics. There was general consensus that the empathetic doctor creates the space where better healing can occur. Amen to that.
The dreaded word is all over the news and causing a flurry of activity at hospitals across the nation as officials scramble to prepare for the possibility of new cases of the West African disease in the United States. So far, just three cases of Ebola have been diagnosed on U.S. soil, all linked to patient Thomas Eric Duncan, a Liberian who contracted the disease in Africa and died at a Dallas hospital Oct 8. However, with the debacle over two nurses who cared for Duncan contracting Ebola, and the search for possible exposures extending from Texas to Ohio, and to multiple domestic flights and a cruise ship, medical facilities are not taking chances.
To date, Los Angeles County has no suspected or confirmed cases of Ebola, according to the county’s public health department. Nevertheless, government agencies and local hospitals such as Cedars-Sinai are training staff and establishing protocols on how to respond to any new cases of the virus, should they appear.
The Jewish Journal asked Dr. Rekha Murthy, director of the epidemiology department at Cedars-Sinai, to explain how the hospital is taking on the challenge of Ebola preparedness, and whether the public should be overly concerned about the disease.
Jewish Journal: How is Cedars-Sinai preparing for Ebola?
Rekha Murthy: Cedars-Sinai is preparing on multiple fronts. We have taken steps to enhance our early detection system for suspected or confirmed cases of Ebola. For example, we are asking all of our patients if they have traveled to Ebola-affected countries in Africa in the last 21 days or if they have been in close contact with someone who has. In addition, we are training our staff on proper procedures for caring for such patients, including how to put on and take off personal protective equipment. Should we receive a patient with signs or symptoms of Ebola virus disease, we will offer that individual the safe, compassionate care that we offer to all Cedars-Sinai patients and ensure that our patients, visitors and staff are safe.
JJ: What kind of training or guidance has Cedars-Sinai received from the Centers for Disease Control and Prevention (CDC)?
RM: We are developing our protocols while monitoring the guidance of multiple health organizations, including the Centers for Disease Control and Prevention, the World Health Organization, the California Department of Public Health and the Los Angeles County Department of Public Health.
JJ: What kind of space and personnel has Cedars-Sinai committed to dealing with a potential Ebola outbreak?
RM: We have identified an isolation unit where a patient with Ebola would receive care, and we have formed a dedicated Ebola Response Team of physicians, nurses and other health care providers.
JJ: If an Ebola case is detected, how will you ensure medical staff caring for the patient does not contract the disease?
RM: In addition to doing hands-on demonstrations with our nurses, physicians and clinical partners, we have filmed a video demonstration of the best practices for putting on and taking off the personal protective equipment. the training also emphasizes proper disposal methods for contaminated linens and supplies. We also will follow the CDC’s recommended “buddy system” in which health care workers observe and check each other during the putting on and taking off of personal protective equipment.
JJ: What is the protocol for dealing with family members and other people who have had contact with an Ebola patient?
RM: Should we admit a patient who is suspected of having Ebola or who has been diagnosed with Ebola, we will work with the state and county departments of health as well as the CDC and follow their guidance regarding quarantine procedures.
JJ: How concerned is Cedars-Sinai about Ebola?
RM: Ebola virus is a serious disease that has caused a lot of suffering around the world. However, the influenza virus is much more widespread here in America, especially in the upcoming months of the usual flu season, and is preventable with flu vaccine. So it is much more likely that Angelenos would catch the flu, not Ebola virus. We are encouraging all our patients to protect themselves and get a flu shot this year — especially children, as this year’s flu appears to be targeting children.
JJ: How worried should members of the public be about Ebola?
RM: Ebola virus is a serious disease, so I understand the concern. However, there is virtually no risk of developing Ebola virus unless you have had close contact with sick Ebola patients with symptoms such as fever, vomiting and/or diarrhea. Transmission of this virus occurs only through direct contact with bodily fluids of patients who are ill with Ebola or from objects such as needles or syringes that have been in contact with these fluids. Unless you have been in contact with Ebola patients or have traveled to the affected countries in Africa or had intimate contact with someone who has been in contact with Ebola patients, there is no need to worry.
JJ: Are you seeing an increase in patients coming to the hospital concerned about Ebola?
RM: No. That said, we are aware of the widespread concern in our community and our country. We are dedicated to patient safety, which always has been our highest priority at Cedars-Sinai.
JJ: What are the symptoms of Ebola that people should be looking out for?
RM: There is virtually no risk of developing Ebola virus unless you have had close contact with sick Ebola patients or have traveled to Africa in the past 21 days. If you have a fever and have traveled to Africa in the past 21 days or have had close contact with sick Ebola patients, seek medical care immediately.
JJ: When should someone seek medical attention if they think they have Ebola?
RM: Immediately. If possible, call your health care provider ahead of time to let them know about your symptoms and that you are seeking care.
In the circumcision wars, circumcision has been winning some big battles.
A new survey of medical data going back more than two decades has found that the health benefits of circumcision far outweigh the risks. The publication of the article on April 4 by the medical journal Mayo Clinic Proceedings is the latest development to tip the scales in favor of circumcision in the long-running scientific, cultural and political struggles over the practice.
Some say this series of arguments has damaged the efforts of American anti-circumcision activists.
“They’re in disarray. They used to be very organized, raising money and so forth,” said Edgar Schoen, a clinical professor emeritus of pediatrics at the University of California, San Francisco, and a longtime champion of the medical benefits of circumcision. “People don’t listen to them that much anymore.”
The authors of the new survey reviewed some 3,000 studies on male circumcision published since 1988 and found evidence indicating that circumcision significantly reduced the chances of contracting a number of diseases, including urinary tract infections, human papillomavirus and HIV.
“When considered together with ethical and human rights arguments, neonatal circumcision should logically be strongly supported and encouraged as an important evidence-based intervention akin to childhood vaccination,” wrote authors Brian Morris, Stefan Bailis and Thomas Wiswell.
Morris, the study’s lead author and a professor emeritus of medical sciences at the University of Sydney, has long been an advocate for the health benefits of male circumcision, authoring the 1999 book “In Favour of Circumcision.”
Circumcision opponents — known in some circles as “intactivists” — generally dismissed the new study.
“It’s very easy for researchers to design their studies and the analysis of their studies to come out with conclusions that they want,” said Ronald Goldman, author of “Circumcision: The Hidden Trauma.” “So they’re finding what they’re seeking, in other words. There’s no objectivity here.”
The so-called “circumcision wars,” as they have been dubbed by the media, spilled into the American political sphere in 2011 when anti-circumcision activists submitted more than 12,000 signatures to place a San Francisco city ballot measure to ban the practice. The measure spurred heated debate as pro- and anti-circumcision advocates traded accusations of anti-Semitism and child abuse.
However, before the measure could go before voters, a state judge ordered it struck from the ballot as a violation of state law. The California State Legislature subsequently outlawed any local bans on circumcision.
The medical landscape tilted against anti-circumcision activists in 2012 when the American Academy of Pediatrics issued revised guidelines on the practice, stating for the first time that “the health benefits of newborn male circumcision outweigh the risks.” This marked a reversal of the academy’s neutral stance and undercut a key talking point of anti-circumcision activists, who had argued that the practice had no support from any major medical organization.
Anti-circumcision advocates disputed the notion that their efforts have run aground, but some acknowledged that the legal and political terrain has become more challenging.
“There was an enormous and immediate clampdown on any type of legislation gaining a foothold to protect male children in the United States,” said Lloyd Schofield, an anti-circumcision activist who served as a spokesman for the San Francisco ballot measure.
However, Schofield and other anti-circumcision activists point to Europe as more receptive territory.
Attempts to limit or ban non-medical circumcision of boys under 18 have intensified in Europe in recent years. The efforts gained steam after a German court ruled in 2012 that circumcision amounted to causing bodily harm — a ruling that triggered brief bans in various locales in three German-speaking countries.
Last October, the Parliamentary Assembly of the Council of Europe issued a non-binding resolution condemning the practice of circumcision for boys as a “violation of the physical integrity of children.” Several Scandinavian political parties and medical associations are seeking a ban, as are the children’s welfare ombudsmen of Denmark, Finland, Greenland, Iceland, Norway and Sweden.
Jewish groups have pushed back strongly against efforts to ban the practice.
Part of the trans-Atlantic difference in attitudes may be rooted in cultural practices. The study in Mayo Clinic Proceedings cited an estimate that only 10 percent of European males are circumcised. In the United States, the authors calculated that neonatal circumcision rates had dropped from 83.2 percent in the 1960s to 77.1 percent in 2010 as a result of demographic and policy changes.
One of the primary reasons cited by the authors for declining circumcision rates is the country’s rapidly growing proportion of Hispanics, who tend to circumcise their children at far lower rates than non-Hispanic blacks and whites. The report cited figures from the Centers for Disease Control and Prevention indicating that only 44 percent of Mexican-American male infants were circumcised, compared with 76 percent of black males and 91 percent of white males. However, the report also noted that circumcision rates among all three groups appear to be increasing.
Another major factor cited by the report for lower circumcision rates was the reduced number of states that provide Medicaid coverage for circumcision. Currently, 18 states do not cover the procedure through Medicaid, up from just six in 1999. Anti-circumcision groups have urged additional states to cease covering circumcisions.
The new study calculates that hospital circumcision rates are 24 percent higher in states that cover the procedure through Medicaid compared to those that do not, after controlling for other factors.
The American Academy of Pediatrics’ 2012 policy statement explicitly urged insurance providers, including Medicaid, to cover neonatal circumcisions. Although there have been reported efforts in several states to restore Medicaid coverage, to date none has made the switch.
Douglas Diekema, a professor of pediatrics at the University of Washington and a member of the pediatrics academy’s task force on circumcision, urged caution in interpreting the study’s findings, saying that circumcision rates are notoriously difficult to calculate because of the number that are performed outside of hospitals. However, he said the impact on decisions by parents would be driven not so much by the data as by media attention.
“It’s not so much that this paper is so radically important as that it seems to be getting a great deal of press,” Diekema said. “Press coverage gets the attention of parents.”
“So, what do you do?” the doctor asks.
“When?” I answer.
“Just … every day.”
“You mean … for work?”
“I’m a writer.”
He’s still waiting. I wait, too.
“So … what else do you do?”
What’s wrong with this guy? I wonder. First, he makes me wait in his stuffy, overcrowded waiting room for a whole hour past my appointment time, then he sends in a nurse, then a physician’s assistant to ask what’s wrong with me and why I’m there, as if the 200-page questionnaire the woman at the front desk made me fill out didn’t cover my financial, social and health history. And now he strides in, all fresh-faced and chipper and interested, it seems, in anything but my upper-respiratory condition.
“I don’t know … I teach writing,” I say, hoping this will be the end of the small talk.
Do doctors ever read the answers they make you write in the questionnaires? Or their nurse’s and PA’s notes? Because, really, everything this guy is asking me is already answered on Page 1 of the encyclopedia I’ve had to write while waiting to be called out of the formal waiting room and into a so-called examination room, which is really just another waiting room, but with a bed and sink and a nurse who asks a thousand intrusive questions, then says, “Doctor will be with you in a few minutes,” and leaves. All this, in the middle of a workday.
The doctor’s still waiting for me to say something.
“I have three kids,” I say, “but they’re all grown.”
He’s still waiting.
Is this guy an ENT or a psychologist?
“Can we talk about why I’m here?” I ask.
He finally gives me a prescription for some antibiotics and lets me get back to work. A week later, his office sends a postcard thanking me for my visit and (this is very classy of them) apologizing for the wait. The respiratory issues are resolved, but the question, spurious as it seemed at the time, stays with me, settles in, and begins to weigh like guilt. What do I do, I wonder, and why wasn’t it enough for the good doctor?
I don’t do much, you see, but I spend all my time doing it. In fact, my entire waking life, these days, consists of two states: I’m either writing or not writing.
Writing is me with my MacBook Air, usually in my car, working on the same novel I worked on last year, and the year before, and the year before that. It’s also what I teach, which takes up a decent amount of time and a great deal of dedication. Not writing is me eating, sleeping, taking a shower, doing the dishes, ordering stuff I don’t need on Amazon and, very occasionally, when my spine feels like it will never move again, going to the gym — in short, wasting good writing time.
Which is why, I realize after days of pondering, I didn’t understand the meaning of the doctor’s question: What do you do, I think he was asking, other than work? As in, what is your hobby?
The word “hobby” has always struck me as bizarre, both its sound and in what it means.
It’s a purely First World creation — like calories — something invented by rich, well-fed and bored Westerners that only they keep track of. A hobby, as I understand it, is an activity one only engages in a.) when one is not working, and b.) purely for fun.
“Not working” and “fun” are also First World contrivances. Everywhere else, you work while you’re awake, and then you die. You work because you have to, or because you want to, or, let’s face it, because you wouldn’t know what to do with yourself if you didn’t work. Otherwise, if you’re rich enough and lazy enough not to have to work every waking minute, you “do” nothing. Or you become a writer or painter, which is the same as doing nothing.
Where I come from, you “do” things for a purpose — usually so you can eat — and if you happen to enjoy what you do, you will either not recognize it or be loath to confess it. In any case, if you’re halfway respectable, you know better than to have “fun” doing or not doing anything, because “fun” usually entails engaging in an immoral activity such as drinking, gambling or adultery.
This is the attitude, even now, in Los Angeles, among most people of my parents’ generation. They’re either working or not working, but either way, you can be sure they’re not having “fun.” They may go to parties, travel with friends, even participate in thrice-weekly card games at one another’s homes, but none of that is done purely for enjoyment’s sake. Instead, it’s by way of fulfilling a social obligation, or a necessary escape from having to spend time with their spouse, or a chore they must undertake in their old age in order to make sure their children and grandchildren find suitable spouses. It’s stressful, expensive and necessary.
Iranians of my generation do give themselves permission to enjoy things, but most of us still suffer from the goal-oriented, success-obsessed, “if you can’t sell it, it’s not worth buying” immigrant mentality. Women who don’t have to work become writers and painters or jewelry designers, or they go to self-improvement seminars and retreats, or sign up for a poetry-as-philosophy course, or get a religion. Overnight, however, having fun becomes either a profession or an obsession. One UCLA extension course or a few sessions of Dr. Shahparaki’s seminars later, the writers feel obliged to become best-selling, award-winning, international sensations, the painters expect to sell their work for six figures or more, and the poetry students all but speak in Shahparaki verse.
Among the men, “fun” is very serious, terribly competitive and usually very costly. They start going to shul just to relax or get away from their demanding wife and noisy kids on Saturday mornings; next thing you know, they’re die-hard Orthodox, plotting hostile takeovers of Conservative synagogues in the interest of making the establishment truly religious. They go to an auto show at the Convention Center, then go home and build a garage the size of the Coliseum, pack it with Ferraris and Bugattis and spend sleepless nights worrying about how many more Ferraris and Bugattis their friends own. A guy I know started out wanting to keep goldfish, and ended up with a koi pond. Then he entered his koi in international beauty pageants. These days, he’s teaching the koi to speak.
As for me, I do the writing for work, and I’m not rich enough or have enough free time to do anything else for fun. It’s not a healthy way to live, I grant you, this total inability to maintain balance and perspective, to do things for the sake of doing them or because they bring you joy. It makes me stressed out, uninteresting and, ironically, useless. It’s also quite embarrassing, as when my grown children ask me, “What did you do today?” and all I have to say, day after day, is “I wrote on my laptop, e-mailed on my laptop, and, for fun, ordered stuff I don’t need on my laptop.” I have enough Japanese shampoo and hair conditioner to turn the entire western coast of the United States into one large bubble bath, but though I live a mere half hour from Santa Monica, I haven’t been to the beach for at least three years. It takes too much time. The sand would get into my laptop. I’d see the water and feel I must include a plot line involving a massive, bubbly, leaves-your-hair-silky-smooth ocean in the book. That would set me back a year. I’m already two years behind. Who said writing is fun?
Gina Nahai is an author and a professor of creative writing at USC. Her latest novel is “Caspian Rain” (MacAdam Cage, 2007). Her column appears monthly in the Journal.