Children play in a water fountain near the Tower of David in the Old City of Jerusalem on April 17, 2016. Photo by Corinna Kern/Flash90 (via JTA).

Millions of Israeli children said at risk of stunted development, possibly from desalinated water


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The survey, whose unpublished results were presented last week to endocrinologists in Ramat Gan, found that 62 percent of school-age children and 85 percent of pregnant women have iodine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.

From left, researchers Dov Gefel, Yaniv Ovadia, Aron Troen and Jonathan Arbelle (Courtesy of Hebrew University)

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 at an event at the Temple Emanu-El Skirball Center in New York City on Sept. 21, 2016. Photo by Michael Kovac/Getty Images

This is Ruth Bader Ginsburg’s workout. Spoiler alert: It’s ridiculously hard.


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.)

The RBG workout

(All exercises include three sets of 10-13 repetitions)

  • – 5 minutes on the elliptical
  • – Stretches
  • – Machine bench press (Ginsburg, who is 5’1” and thin, presses 70 pounds)
  • – Leg curl machine
  • – Leg press machine
  • – Chest fly machine
  • – Lat pull down machine
  • – Seated rows
  • – Standing rows
  • – One-legged squats
  • – Push-ups (Ginsburg started doing them against the wall, but progressed to doing them on her knees and now with straight legs)
  • – Standard plank (30 seconds)
  • – Sideways planks (30 seconds on each side)
  • – Hip abduction exercises
  • – Squats against exercise ball and wall
  • – Dumbbell curls against exercise ball and wall
  • – Platform step-ups
  • – Squats on an upside-down bosu
  • – Medicine ball tosses while standing up off of a bench and sitting back down

Jewish patients taking new look at rhinoplasty


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.”

health1Even 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.

health2Dr. 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.”

Virtual reality helping elderly reduce falls


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.”

Game-like simulation

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.”

Cures for age-old problems


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

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

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.

Depression

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.”

Alzheimer’s disease

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.

Eye problems

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.

Accepting the end


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). 

California, Israel to partner on stem cell research


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.” 

New study: Sperm quality damaged by cellphones


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. 

Jews, non-Jews and weight loss


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.

In defense of Jewish circumcision


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).

When it’s time to die


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.

Israeli scientists make steps toward decoding human genome


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.

Diabetes in Salinas: Why won’t a city world-famous for agriculture eat its vegetables?


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. 

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Israeli shoes (re-)teach the brain how to walk


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.”

Scoping out the senior scene


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.” 

A mother’s campaign for a cure


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?”

A Mishkan for all: A communal approach to mental illness


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.

‘Sleepless in America’ reveals eye-opening truth about lack of sleep


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.”

Healing: Where religion and science meet


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.

Preparing for the worst: A conversation with Cedars-Sinai’s director of epidemiology on Ebola


Ebola.

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.

Health benefits of circumcision reinforced


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.”

You can have fun when you die


“So, what do you do?” the doctor asks. 

“When?” I answer. 

“Just … every day.”

“You mean … for work?” 

“Or otherwise.”

“I’m a writer.”

“You are?”

“Yes.”

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. 

“You do?” 

“Yes.” 

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.

Finding a cure


Israel’s reputation as a tech pioneer extends far beyond wireless technology and computer chips to the biomedical field. While some of the most ingenious treatments are being developed at Israeli universities, others are being launched by private start-up companies.  

Here is a sampling of the many advances in the industry — some in the pipeline, others already on the market. 

Cervical cancer can be cured if it is caught early, but that rarely occurs in the developing world, resulting in 250,000 cervical cancer deaths a year worldwide. MobileOCT, a Tel Aviv start-up launched in October 2012, has developed a scope that can be attached to a smart phone, a digital camera or an endoscope to capture the data required to make a diagnosis. The device absorbs the light reflected from cervical tissue and turns it into a high-resolution image that is then analyzed by an algorithm developed by MobileOCT. 

According to Ariel Beery, the company’s co-founder, 2 billion women lack access to cervical cancer screening. In December, Beery and MobileOCT won the $100,000 first prize in the International Startup Festival’s Elevator World Tour, a competition for top startups. Now in the testing phase, the prototype is expected to go live in 2015.  

Many patients with sleep apnea, characterized by brief interruptions in breathing during sleep, live with this potentially fatal condition because the pressure masks their physicians prescribe, which are meant to keep oxygen flowing, are just too uncomfortable. Discover Medical Devices has created SomnuSeal, an adjustable mask it describes as nonintrusive and “much more comfortable” because it doesn’t come into contact with any sensitive oral or facial structures.   

The mask uses continuous positive airway pressure (CPAP) to keep the airways open. This is the same treatment used for preterm babies whose lungs haven’t fully developed, according to the National Institutes of Health. Discover Medical, which is marketing the product in Europe, hopes to enter the U.S. market as well. 

People with type-2 diabetes who depend on insulin injections may have an alternative in the foreseeable future. Jerusalem-based Oramed Pharmaceuticals has developed an oral insulin capsule intended to take the place of daily injections. The capsule is in Phase II clinical trials.

 “Going to market is a few years downstream,” said the company’s COO, Josh Hexter, referring to the long clinical trial process required before any medication is approved.

The company believes the capsule will be most beneficial in the early stages of type-2 diabetes, when it can still slow the rate of degeneration of the disease by providing additional insulin to the body before the pancreas can no longer produce any insulin. Diabetes is a metabolic disorder in which a person has high blood sugar, either from the body not producing enough insulin (type 1) or because the cells have developed a resistance to the body’s own insulin (type 2).

Professor Zeev Zalevsky at Bar-Ilan University has developed a bionic contact lens that, he believes, will eventually give sight to people who were born blind. The product utilizes a small camera, held in the hand or worn on glasses, that transmits information to a special contact lens. Electrodes transmit signals of the image, which can be described as “electronic Braille,” which are in turn felt by the retina. 

“It’s like reading Braille, not with your fingertips but with your eyes,” Zalevsky explained in an online university newsletter. “We can encode an image with many more points than the Braille system and use these to stimulate the surface of the cornea.”

Zalevsky’s team is conducting feasibility studies on people with normal sight as a prelude to seeking approval for clinical trials. 

When President Barak Obama visited Israel last year, the government invited him to see some of the country’s most impressive tech inventions. The ReWalk exoskeleton was one of them. 

Awaiting FDA approval in the U.S., the exoskeleton created by Argo Medical Technologies, southeast of Haifa, enables paraplegics to sit up, walk and climb stairs. Used in rehabilitation hospitals in Israel, the U.S. and Europe, ReWalk is also available for private use in Europe. 

Powered by batteries, the exoskelton’s motorized legs are controlled by portable computers and motion sensors. The developers are currently examining whether ReWalk increases patients’ bone density and improves bodily functions. Featured on the TV show “Glee,” the product was named one of the “25 Best Inventions of the Year” for 2013 by TIME magazine.

Na-Nose, which was developed by a team of scientists at the Technion-Israel Institute of Technology, is a system that tests and detects lung cancer from exhaled breath with a high rate of accuracy — it is able to differentiate between different types of cancer up to 95 percent of the time.    

The company’s goal is to detect early stages of cancer in a noninvasive way. A year ago, the scientists teamed up with the Boston-based company Alpha Szenszor, which manufacturers nanotube sensing equipment, to conduct more testing and seek FDA approval within five years.   

Na-Nose analyzes the more than 1,000 different gases that are contained in a person’s breath and identifies those that raise red flags. The gases bind with nanomaterials and the results are analyzed. The developers are seeking ways to apply the technology to the detection of multiple sclerosis, kidney disease and Alzheimer’s disease, as well as other cancers.  

OrCam, a device that reads text from newspapers, road signs, menus, food labels and more, helps the visually impaired navigate the world. The product, made by a Jerusalem-based manufacturer of the same name, consists of a tiny camera that attaches to a pair of eyeglasses. A cable links it to a pocket-sized computer, which converts the words into speech when the user points to an object. 

Available only in the U.S. and in English — although it is currently sold out, according to its manufacturer — the manufacturers are planning to distribute the device more widely and in different languages. 

A day to learn about women’s wellness


Quick. And no using your smart phone. What is the No. 1 killer of women in the United States? If you answered breast cancer, you’re close. Indeed, breast cancer takes far too many lives each year. But it is No. 2. No. 1 is heart disease.

Ready for another one? Chia seeds: Just the latest contemporary food fad right? Nope. The so-called super seed has been around for thousands of years and was integral to both the Aztec and Mayan diets. And, according to Los Angeles-based integrative nutritionist Marlyn Diaz, ounce for ounce, they contain more Omega-3 fatty acids than salmon. “They make your hair grow and your skin glow,” she says.

Intrigued? Then you may want to attend Hadassah’s Women’s Wellness Day. The all-day program takes place Feb. 9 at UCLA Covel Commons. Although the event is expected to sell out, tickets were still available when this article went to press. Among the scheduled speakers are Dr. C. Noel Bairey Merz, director of the Barbra Streisand Women’s Health Center and the Linda Joy Pollin Women’s Heart Health Program at Cedars-Sinai; nutritionist Diaz; and Dr. Kristi Funk, co-founder of Pink Lotus Breast Center — and Angelina Jolie’s doctor.

Hadassah has a long history of promoting women’s health. The organization’s first mission, in fact, in the early 1900s, sent two nurses to Palestine to provide pasteurized milk to new mothers and their infants. And while Hadassah’s two medical institutions are located in Jerusalem, the research undertaken there benefits women worldwide, notably the discovery of a 10 percent greater frequency of the BRCA genetic mutation (which predisposes women to breast cancer) among Ashkenazi Jewish women. 

Last year, Hadassah launched Every Beat Counts to educate women about heart disease. And February is American Heart Month, so it is fitting that Hadassah’s first major health symposium in Southern California is taking place this month.

Attendees can customize their experience by selecting from several expert-led sessions on topics including “Mindful Stress Reduction” — who doesn’t need that in go-go Los Angeles? — “Caring Options for Your Loved Ones” and “Is Your Food Aging You?” All who attend will hear from Funk, who, along with patient Jolie, brought breast health to the forefront and who will be giving the morning keynote, and Bairey Merz, the lunchtime keynote speaker.

Among other topics, Bairey Merz will talk about the different ways in which women’s and men’s heart disease manifests. 

“Women are more likely than men to have their heart attacks missed,” Bairey Merz said. “Women’s symptoms are not as typical as men’s symptoms.” But, she added, “We always have to point out the reason we think of typical symptoms is that they have been described in men. If we had started the other way around, men would be considered atypical. A lot of health care is set to a male standard.”

We all know what has been dubbed a Hollywood Heart Attack looks like. Not to make light of it, but it generally looks like this: A man is giving a speech (or eating his dinner, or shooting hoops, etc.), and then he is suddenly clutching his chest, turning red in the face and falling to the floor.

Women’s symptoms — and, to be fair, many men’s — are more subtle. So, how does a woman know when to seek medical attention?

“The standard advisement,” Bairey Merz said, “ is any symptom above the waist, above the belly button, that is not routine or otherwise explained. If you always get heartburn after eating a chili dog, it is probably heartburn. But if you wake up in the middle of the night with heartburn, it might be a heart attack.”

Bairey Merz will discuss five health habits associated with reducing heart disease. No. 5, she says, is a favorite of many: “a single serving of alcohol every day taken with a meal.”

“It’s pretty clear that anywhere from 80 to 90 percent of cardiovascular disease is related to lifestyle habits that we have some control over,” she said.

Diaz will be doling out tips as well, including her favorite super foods. The aforementioned chia seeds, raw cacao and Brazil nuts are among them. She will also talk about sugar — not eliminating it, but reducing it — and choosing better sugars. “Food companies have gotten smart,” she said. “There are over 50 names for sugar that they use. So many of us are trained to look for a couple: dextrose, sucrose — the ‘ose’-es. There are a lot of different ways it is hidden in food.”

Rest assured that Diaz will not be making a bogeyman of your latte or bagel. “It’s all about baby steps and elevation: How we can elevate our food choices?” she said. “All the small changes add up to big changes over time.” 

According to Sandi Sadikoff, president of Hadassah Southern California, “This is not an age-defined event. We are encouraging women to bring their mothers, their daughters, their nieces.

“The best-case scenario is some woman sitting out there in the audience hears something that Dr. [Bairey] Merz or Dr. Funk says, or any of our other physicians, and realizes that they have to go to their doctor because there’s a symptom they have been ignoring. We may save someone’s life that day.”

For more information on the event or to register, visit http://southerncalifornia.hadassah.org/womenswellness or call (310) 276-0036.

The power of two


Lee Shoag is the kind of husband who tells his wife he loves her wrinkles.

Barbara Shoag says her husband’s excess pounds mean she has more of him to hug.

But when the Reform Jews from Long Beach, both 74, took a whitewater rafting trip several years ago and found themselves easily losing their breath, the couple agreed they both needed to improve their cardiovascular health.

So, at 6 a.m. most mornings of the week, the Shoags head down to Long Beach’s Alpert Jewish Community Center to work out. Barbara, who prefers guided instruction, takes a spin or Pilates class. Lee, a more independent exerciser, uses the elliptical machine and weights. But no matter what type of exercise they each end up doing, the Shoags always make their trips to the gym a joint affair.

“We’ve been married going on 50 years, and we like doing things together,” Lee explained.  “It’s more motivating to have each other.”

When it comes to making healthy lifestyle changes, the Shoags have it right. Couples who support each other when it comes to working out, eating right and following the doctor’s orders tend to enjoy significantly greater success in getting and staying healthy than people who embark on such efforts alone, research shows. That’s especially true for people over 50, who typically face greater health challenges as they age and may be more reliant upon each other than in their younger years, experts say.

Benjamin Karney, a professor of social psychology at UCLA, has studied the issue in depth. He said couples can’t help but affect each other when one partner decides to make a lifestyle change, or is ordered to do so by a doctor. How the supporting partner chooses to respond — or not respond — to his or her loved one’s desire for change is critical to the other’s ultimate success, Karney indicated. 

“What I eat at a table, how much I eat, is powerfully affected by how much the people around me are eating, especially my intimate partner,” said Karney, a secular Jew who lives in Santa Clarita. “What I have to eat in my kitchen is powerfully affected by what my partner shops for when my partner goes to the market. Whether I have time to go to the gym depends on how much my partner is willing to do at home while I’m at the gym.”

These issues and more are addressed in an upcoming book titled “Love Me Slender: How Smart Couples Team Up to Lose Weight, Exercise More, and Stay Healthy Together,” to be released Feb. 4 by Karney and Thomas Bradbury, co-directors at the UCLA Relationship Institute. It outlines several ways partners can help each other implement lifestyle changes. These include creating an environment that is conducive to maintaining a healthy change without resorting to nagging or criticism. For example, if a better diet is the goal, the supporting partner can buy healthier food and avoid leaving junk food where the spouse might see it. If the goal is improved fitness, one could start going to the gym and invite the partner along, Karney said.

Cindi Massengale, fitness and wellness manager at the Alpert Jewish Community Center, said she encourages people who are making lifestyle changes to try and get their partner on board. That doesn’t mean couples have to do the same activities as each other — everybody has different preferences and abilities — but they can be supportive by accompanying their partner in some way, she said. Massengale said she sees many couples like the Shoags who go to the community center together, but one will work out in the gym while the other goes to the library or takes a class. 

“If they’re coming together, they’re more accountable to each other and keeping each other on track,” Massengale said. “Just getting out of the house can be the hardest part.”

One area where couples tend to make mistakes when it comes to healthy lifestyle changes is in communication, Karney said. Conversations about weight, body image and fitness can become very emotional. A spouse might interpret his or her partner’s desire to do more exercise as a criticism of their lifestyle together or might fear their partner wants to lose weight to impress somebody else. It’s important couples take time to understand each other’s perspective and unite around making a change, Karney said. This understanding approach can also be helpful when a partner is struggling to improve habits or follow the doctor’s orders.

“When you’re tempted to offer a criticism or a critique, or make a demand, try asking a question instead,” Karney said. “You might ask, ‘What makes it hard for you?’ You might ask, ‘What are your goals?’ There’s a lot of strength in being heard. … It’s a way to show your understanding, and it’s often a good beginning for making a change.”

Couples can also remind each other of why health changes are important by focusing on a vision of a long-term future together, the professor said. It’s easier to make short-term sacrifices, such as resisting a piece of chocolate cake, when you remember that you’re investing in a happy future with the person you love, Karney said.

Of course, support can come from someone other than a spouse. A six-week healthy living program for seniors run by Jewish Family Service of Los Angeles encourages participants to team up with a “buddy.” That could be a spouse, or another course participant, a friend or a caregiver. Participants set weekly goals for themselves to improve their health, and the buddy reminds the person of their goals, makes sure they’re on track and celebrates with them when goals are achieved, said Monica Dunahee, manager of senior adult education, health and wellness. 

“As you become older, its going to be harder to get fit, to eat right,” Dunahee said. “You need someone in your corner, someone to be accountable to and to celebrate with you.” 

Awaiting transplant, family rallies with hope


Michael Goldberg’s heart is working just fine.

The University of Washington professor teaches a class on romantic comedies. From “Annie Hall” to “Pretty Woman,” he leads his students on a tour of film’s fondest genre.

What Goldberg needs, however, is a new kidney, and it’s not the first time. His lone kidney is a failing transplant from nearly two decades ago.

It all started when he was a 15-year-old living in Los Angeles. He was diagnosed with Type 1 diabetes, a disorder in which the pancreas stops producing insulin, a hormone that converts sugar into energy. Blood sugar levels rise, causing excessive thirst and urination, as well as potential organ damage down the line. 

Looking back, he wishes he’d taken better care of his body after the diagnosis. 

“I was probably not in good control for three or four years,” Goldberg said. “It was a combination of I was a semi-alienated 15-year-old, and I had ADD.”

A 2.0 senior year GPA didn’t stop him from enrolling at the University of California, Santa Cruz, where he found a good doctor and started to regulate his condition. But in 1986, while earning his doctorate at Yale, he was diagnosed with kidney disease. 

He got married and took a professor position in the Seattle area in 1993. Soon after, his failing kidneys finally gave out.

“I had to go on dialysis suddenly,” he said. “There were a lot of complications, and
it was tough.”

He began going to the Northwest Kidney Centers three days a week for the blood-cleansing treatment, which involves a machine artificially filling the role of the kidneys. Blood is drawn from the body, typically through a vein in the arm, then cleaned and streamed back in. 

In addition to needing a new kidney, doctors told Goldberg he needed a new pancreas. This promised to cure his diabetes, a pancreas-based disease, but ruled out the prospect of a living donor. He was put on the waiting list for a pancreas-kidney transplant in 1995. Just nine months later, he received the organs from a cadaver donor — a recently deceased teenager whose parents wanted their son’s organs to live on.

Goldberg in his office on the Bothell campus of the University of Washington, where he teaches history and film.

The new kidney fit right in for 17 years, which is outstanding for a cadaver donation. But the powerful medication that organ recipients must take can eventually be toxic to the new organs.

“Most kidneys fail not because your body rejects them,” Goldberg said. “It’s because you’ve been scarring the kidney through the immunosuppressant drug.”

In fall 2011, the lab results came in: The pancreas was in good shape, but Goldberg needed another kidney.

He went back to the Northwest Kidney Centers, but this time for training rather than treatment. He and his wife, Elizabeth de Forest, learned how to do home dialysis and set up shop in their bedroom in August 2012.

Home dialysis is done five nights a week and takes about five hours a night. De Forest throws on a lab coat and latex gloves and inserts a needle into her husband’s fistula, a surgically created passage where a vein has been connected directly to an artery. The vein is about as thick as a piece of licorice — strong enough to be drawn from night after night.

A preschool teacher by trade, De Forest took the year off to be by her husband’s side. “I’m pretty much on call if anything happens,” she said.

Studies have shown that home dialysis can reduce stress on the heart and improve survival rates. Still, 90 percent of dialysis patients prefer to go to a center. Many cite a feeling of safety that comes with having the process done by professionals.

But, for Goldberg, there’s no place like home. He loves having his wife and two sons, Asher and Jonah, around to support him. There’s a flat-screen TV in the bedroom, with boxes of DVDs on one side and boxes of syringes on the other.

“It can be stressful at times but, you know, usually we’re used to it,” said Asher, 14.

“It’s not just him on the machine,” said 12-year-old Jonah. “It’s sort of like all of us.”

Michael Goldberg and his wife, Elizabeth de Forest, setting up the home dialysis process.

Goldberg attends the Reform Temple B’nai Torah in Bellevue, Wash., where he has relied on the clergy as a source of support since learning that the transplant was giving out.

“Even though I was really sick, I was trying to make it for Saturday services,” he said. “My blood pressure was going up and down — people were always looking out for me. But just to be there was so important. I really feel my faith helps me get through this stuff.”

An especially tough stretch came around the time his son Asher was turning 13. On the Friday night of the bar mitzvah, Goldberg was in such terrible shape that he had to leave and lie down. At the following day’s ceremony, though, he got up and danced.

“The bar mitzvah became this remarkable moment,” he said. “It really felt like a blessing.”

Goldberg’s parents, Irving and Esther Goldberg, live in Encino. His father was so touched by his son receiving the first kidney that he started a nonprofit called Transplant for Life.

“I felt I had an obligation to return my expertise in a way that would help increase organ donation,” the elder Goldberg said. “Transplant for Life was based on the mission of increasing donor awareness among the interfaith religious communities in our nation.”

They provided speakers for synagogues, churches and mosques and distributed kits that included sample sermons and prayers. For years they participated in the annual National Donor Sabbath, a three-day observance that encourages a nationwide dialogue about organ donation. This year’s Sabbath ran from Nov. 15-17.

While the transfer of organs can be contentious in Jewish culture, Transplant for Life found wide support.

“We researched all denominations of the Jewish community: Reform, [Conservative], Orthodox, ultra-Orthodox,” Irving Goldberg said. “We had close to an 80 percent positive response.”

The only real resistance came from the ultra-Orthodox, but even there, some approved of the process so long as specific criteria were met.

Transplant for Life was eventually absorbed by the Transplant Recipients International Organization.

The organ waitlist looks a lot different now than it did in 1995. There are more than 120,000 people who need an organ, and about 18 of them die each day. What once took six to nine months can now take up to five years, depending on blood type. For Goldberg, whose blood type is A, it’s two to three years, but he doesn’t even know where he’s at on the list.

The alternative to the waitlist is finding a living donor. Often family members or loved ones volunteer to help out. Goldberg found out the first time around that his close family members have positive cross-matches, meaning his antibodies will reject their blood cells. 

He had a donor lined up last spring, a friend whose kids attend school with his, but doctors discovered a rare condition in her kidney that meant she wasn’t a candidate. 

Donating a kidney traditionally required the removal of a rib. Now there’s a less invasive laparoscopic procedure with improved success rates and recovery time. Research shows giving a kidney doesn’t affect long-term health or lifespan. 

“You never know, there are people now donating kidneys who don’t know anyone,” Goldberg said, referring to so-called altruistic donations. “They just say, ‘I want to donate a kidney,’ and get connected.”

For now, it’s five nights a week on the machine. 

“It can be a challenge,” Goldberg said. “It’s emotional. I think we deal with it really well. You’re dealing with your body — you’re dealing with needles and blood and those sorts of things.”

But like any good professor, Goldberg tries to keep things in perspective.

“I was talking to the cantor a couple days ago. He was saying that for people who have a larger spiritual outlook — whether religious or just based on concern for a larger purpose in the world — it’s easier to fight off the feeling of self-involvement about your condition. Mine is bad, but there are worse things. Look outward. Ask yourself not just why you want to live, but what do you want to do that day in the world? Look beyond yourself.”


For more about Goldberg’s story, visit http://www.caringbridge.org/visit/michaelgoldberg

With electromagnetics and metal caps, Israeli companies aim to zap brain diseases


It looks like a futuristic salon hair dryer.

Connected to a computer by a bright orange strip, the half-cube with rounded corners sits comfortably atop the head, a coil of wires resting on the skull.

As a doctor stands at the computer, the patient gets comfortable. A few seconds later, a brief electromagnetic pulse hits the head.

Do this every weekday for six weeks, doctors tell Alzheimer’s patients, and you’ll feel your brain come back to life.

The technique, known as transcranial magnetic stimulation, or TMS, uses electromagnetic waves to penetrate the brain and activate underused neural connections.

Two Israeli companies are hoping it will change the way brain diseases are treated.

“This is the first time in neuroscience that we have a noninvasive tool to directly penetrate and influence deep structures of the brain in a targeted way,” said Ronen Segal, the chief technology officer of Brainsway, based in Jerusaslem. “No shocks, no hospitalization. You come into the clinic, you sit in the chair for 20 minutes, you get a series of electromagnetic zaps.”

Unlike electroshock therapy, now known as electroconvulsive therapy, or ECT — a risky and controversial procedure long used to counteract severe depression and other disorders — TMS targets specific regions of the brain rather than the whole organ and at a much lower intensity. Unlike ECT, Brainsway’s clinical trials show TMS carries almost no risk of seizure.

Brainsway is working on using TMS to combat a range of diseases. The company received approval this year from the U.S. Food and Drug Administration to treat depression with TMS, and has European Union permission to use the technique to treat 10 diseases or disorders, including Alzheimer’s, Parkinson’s and autism, even tobacco addiction. Other drug addictions and obesity are next on the company’s list.

Another Israeli company, Neuronix, focuses on Alzheimer’s, which affects 5 million Americans — a number sure to rise as the baby boomer generation ages.

“Every emotion, thought or action starts with electric activity in the brain,” Segal said. “The problem is if you have too much or too little activity, you get a brain disorder.”

In a person suffering from depression, for example, the section of the brain that regulates mood isn’t as active as it should be. Electromagnetic pulses targeting that section stimulate brain cells to fire, restoring them to a normal level of activity, Segal says, and teaching them to be more active in the long term.

For Alzheimer’s patients, treatment entails an additional step. Patients who receive Neuronix’s electromagnetic pulse have less than a minute of increased brain activity. During that window, a computer screen flashes a simple task meant to exercise the affected region of the brain — asking patients, in one example, whether two sentences mean the same thing.

Affirming that “The salad has tomatoes” equals “There are tomatoes in the salad” helps sustain the short-term benefit of TMS therapy.

“To understand [the sentences], to process them, to understand whether they have the same meaning, is a challenge,” said Orly Bar, Neuronix’s vice president for marketing. “We want to get to a point where the mechanism improves.”

While both companies emphasize that treatment should complement existing medication, not replace it, clinical trials show that TMS can be more effective in counteracting Alzheimer’s than current medications. And unlike pills that enter the bloodstream, the electromagnetic zaps have no side effects.

“We know there’s medicine that works on the same mechanism,” Bar said. “There’s no contradiction. They can work together great.”

Neuronix and Brainsway were both featured at Braintech Israel 2013, a conference in October highlighting Israel’s growing brain technology industry. Along with medical advancements, the conference showcased innovation in fields such as brain modeling and mind-control gaming.

“It’s widely accepted that we’ve made a lot of progress in heart disease and cancer,” said Miri Polachek, executive director of Israel Brain Technologies, the nonprofit that organized the conference. “The one area where we need to make a big push is the field of brain research.

“It’s no longer science fiction. You can see these things becoming real.”

Dr. George Berci: Beyond the scope


Those who know Dr. George Berci describe him as a visionary, and it’s not just because the world-renowned surgeon pioneered the techniques that serve as the foundation for endoscopic procedures that have changed the field.

At 92, the Holocaust survivor is still contributing to medical advancements as the senior director of minimally invasive surgery research at Cedars-Sinai Medical Center.

“The techniques he developed have had a profound impact on a generation of surgeons,” said Dr. Bruce Gewertz, chair of the department of surgery at Cedars-Sinai. “He is a towering figure in our profession.”

Endoscopy is a procedure that allows doctors to view the inside of the body using a tiny camera attached to a thin, long tube. It can be used for diagnostic purposes or, when used in surgery, allow for smaller incisions that allow for a faster recovery and fewer side effects.

As an innovator in endoscopy techniques and technologies since the 1950s, Berci’s work not only led to new visualization techniques, instrument minimizing and high-definition cameras, but also took him to 40 academic institutions around the world where he taught surgeons and continued to improve the imaging and viewing capabilities of endoscopes.

His first love, though, was music. Originally from Szeged, Hungary, Berci moved with his family to Austria in 1922 when his father was hired as the assistant conductor of the Vienna Philharmonic Orchestra. As a child, he learned to play the violin and by 10 he was playing concertos.

In 1936, his family returned to Hungary to escape from the rising anti-Semitism in Vienna, although discrimination continued to be prevalent. In 1942, at the age of 21, Berci was taken to a forced labor camp, where he spent the next two years. Later, he was transferred to Poland to unload explosives. 

“There were people in my age group who were sick. For instance there were a couple of epileptic boys. Some of the wardens didn’t believe they were sick and put them out in the snow; they died there,” Berci said. “At that time, life didn’t mean very much because we saw how many of our friends were killed. Therefore you became very fatalistic.” 

After narrowly avoiding being sent to a concentration camp — Berci said the train car he was on was abandoned by guards — he eventually was reunited with his mother and began working with the Hungarian underground. At the war’s close, he returned to Szeged in search of food and with the hope of studying music at the academy.

“I understood music,” Berci said. “Having a Jewish mother, she told me that under no condition will you be a conductor — you will be a doctor.”

In 1945, he was accepted into medical school in Szeged, graduating summa cum laude, and his interests emerged in the areas of experimental surgery and instrumentation. Following the failed 1956 Hungarian Revolution, Berci immigrated to Australia on a Rockefeller Fellowship. 

“There are more kangaroos there than people,” said Berci, who in 1957 was the first foreign physician accepted as a surgeon and a teacher. “I didn’t speak a word of English, and they gave me six months to learn the lingo to teach medical students.”

He worked on the challenges of surgery visualization, and during a visit to London, met with inventor Harold Hopkins, who was working on a separate approach to the subject. Berci then introduced Hopkins to Karl Storz, founder of the eponymous company known for manufacturing medical instruments, to help make their optical advances come to fruition.

And while most people still didn’t own a television, Berci published a paper in 1961 called “Medicine and Television,” and started recording surgery. 

In the 1970s, Cedars-Sinai had an understanding for the needed specialization for endoscopy, and Berci — who arrived there in 1968 as a visiting professor — joined the faculty as director of the multi-disciplinary surgical endoscopy unit. 

Over the years, Berci has written more than 10 books, 200 scientific papers and produced more than 40 teaching films.

Recognizing that surgical training was poor, he set up teaching and guidelines as a founding member and past president of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES), which aims to improve the quality of patient care, principally in gastrointestinal and endoscopic surgery. 

“We have to change our educational system,” Berci said. “We are over-technical — we don’t ask the patient how he feels and should take time to examine the patient more closely.”

Today, SAGES has created the George Berci Lifetime Achievement Award in Endoscopic Surgery, its highest honor. They debuted a documentary film about Berci’s life and innovations at the annual SAGES conference this past April in Baltimore.  

“It’s just a riveting story all the way through,” said Dr. Michael Brunt, president elect of SAGES and director of Berci’s film. 

“The film is really about a man who was so resourceful at every turn and who went through many trials and difficulties, yet he persisted,” he said.  “Somehow he managed to survive when it was not easy and became one of the great surgeons and innovators.”

Last year, Berci also received recognition in Budapest where he was awarded an honorary doctorate from Semmelweis University and a building in his name.

Berci, who continues to sleep with a yellow pad by his bedside in case he wakes up with an idea, still thinks he would have been a superb conductor. 

“I still love music, and this is one aspect that I don’t forgive my mother.”

Writing can diagnose Parkinson’s


A new Israeli study comparing the handwriting of healthy people to those with Parkinson’s disease holds out the promise of providing a simple diagnostic tool at the earliest stages of the progressive disorder caused by the death of nerve cells in the brain’s muscle-movement control areas.

As many as 10 million people worldwide suffer the tremors, impaired balance and rigidity associated with Parkinson’s, which has no cure. In the United States, about 60,000 Americans are diagnosed with the disease each year, according to the Parkinson’s Disease Foundation. 

The handwriting study is the latest of many Israeli investigations into Parkinson’s. Unfortunately, physicians can diagnose the disease definitively only by observing clinical symptoms that appear at a relatively advanced stage, or by administering a test called SPECT, which uses radioactive material to image the brain.

But researchers at the University of Haifa and Rambam Medical Center in Haifa believe their study shows how the disease can be detected sooner, noninvasively and without radiation.

“Identifying the changes in handwriting could lead to an early diagnosis of the illness and neurological intervention at a critical moment,” explained Sara Rosenblum of the university’s department of occupational therapy.

She said that publication of results in the journal of the European Neurological Society aroused great interest at the International Congress of Parkinson’s Disease and Movement Disorders held last summer in Sydney, Australia.

Rosenblum initiated the study, which compared handwriting samples from 40 subjects, some of whom had Parkinson’s and some of whom were disease-free. She was building on previous research that has shown unique and distinctive differences between the handwriting of Parkinson’s patients and that of healthy people. However, most of those studies focused on motor skills (drawing spirals, for instance) and not on writing that involves cognitive abilities, such as signing a check or copying addresses.

According to Rosenblum, Parkinson’s patients notice a change in their cognitive abilities even before they experience a change in their motor abilities.

Her handwriting research was conducted in cooperation with Dr. Ilana Schlesinger, head of the Center for Movement Disorders and Parkinson’s Disease at Rambam, and occupational therapists at the hospital.

Half of the 40 participants were known to be in the early stages of Parkinson’s disease, before obvious motor signs are visible. The subjects were instructed to write their names and to copy addresses — two everyday tasks that require cognitive abilities.

The writing was done on a regular piece of paper placed on an electronic tablet, using a special pen with pressure-sensitive sensors. A computerized analysis of the results compared writing form (length, width and height of the letters), time required and the pressure exerted on the surface while performing the assignment.

There were significant differences between the Parkinson’s patients and the healthy group, and all subjects, except one, had their status correctly diagnosed (97.5 percent accuracy).

The Parkinson’s disease patients wrote their letters smaller, exerted less pressure on the writing surface and took more time to complete the task. Rosenblum said the most striking difference was the length of time the pen was in the air between the writing of each letter and each word.

“This finding is particularly important because while the patient holds the pen in the air, his mind is planning his next action in the writing process, and the need for more time reflects the subject’s reduced cognitive ability,” she said. “Changes in handwriting can occur years before a clinical diagnosis and therefore can be an early signal of the approaching disease.”

Validating these findings in a broader study could pave the way for this method to be used for a preliminary diagnosis of the disease in a safe and non-invasive fashion. 

“This study is a breakthrough toward an objective diagnosis of the disease,” said Schlesinger, noting that this method would reduce the load on the health system because the test can be performed by a professional other than a doctor.

The researchers are currently applying the same method in a new experiment, using handwriting analysis to evaluate the degree of functional improvement in Parkinson’s patients who have received brain-implanted pacemakers.