Wednesday, May 9, 2018

Yale Medicine Review of Longevity Decoded

We all age. As the years go by, we get grayer, develop new wrinkles, and feel less spry than we once did. It is just part of life, right?Well, what if there was a way to dramatically slow down the aging process? According to Stephen Schimpff, MD, MACP, there is. In his new book, Longevity Decoded: The Seven Keys to Healthy Aging, Schimpff identifies the seven "keys" to living longer and healthier lives.

Before you roll your eyes, you should know that this isn't some New Age, woo-woo mumbo-jumbo. Schimpff's longevity "keys" are both practical and deeply rooted in science.

In fact, you've probably heard most of them before: Eat a healthy diet, exercise, get enough sleep, avoid tobacco, manage stress,stimulate your brain, and engage socially. These so-called "keys"aren't necessarily new or groundbreaking, Schimpff concedes, and many are intuitive. Taken together, though, they can have a real and measurable effect on your life.

"We're always told to start saving for retirement when we're young because it will compound and our investment will grow," he says. "What I wrote about is the same message: If you start early, the benefits will compound over time."

Longevity is more than just a list of what you should and should not eat or do as you get older. It's an accessible and entertaining overview of the latest research on aging, detailing what scientists currently know about the process at a cellular level and what they're studying in laboratories around the world.

Is aging caused by free radicals? The structure of our DNA?The health of our gut microbiome? Turns out that while there's compelling evidence about each of these things, the science just isn't there yet.

"There are a lot of ideas about why we age; yet, when you get right down to it, we really don't know. We don't know what turns it on,and we don't know what turns it off," Schimpff says. "For all of our biomedical research since WWII, not that much has been spent studying the aging process."

As more and more people live beyond 65 years of age--an estimated 19 percent of the world's population will be older than 65 by2030--that is changing. What's more, as research increasingly shows that our bodies begin to decline as early as 30-years-old, concerns about aging are no longer just relegated to the elderly.

"Everybody knows that we should eat better, exercise, soon, but most people don't know why," Schimpff says, adding that people often think superficially and in the short-term when it comes to health.

"We need to get away from that and talk about our health and keeping healthy for the long-term. And if there's a message in this book,it's that we have it within our power to make a very significant change in our life... can we prevent every disease? Absolutely not. But as individuals, we can have a huge impact."

Condensed from a review by Miriam Wasser in Yale Medicine, April, 2018 


Longevity Decoded Press Release

FOR IMMEDIATE RELEASE                                                      
Contact:           Stephen C. Schimpff, M.D.                           

 New Book Reveals Seven Proven Actions to Slow Aging and Chronic Illnesses

Leading physician and healthcare expert shares how aging can be slowed

BALTIMORE, Md., April 26, 2018—A new book by a nationally recognized physician leader and healthcare policy expert reveals seven ways you can slow the aging process and prevent many chronic illnesses. In Longevity Decoded – the Seven Keys to Healthy Aging, Stephen C. Schimpff, MD, former Chief Executive Officer of the University of Maryland Medical Center, reveals how much our daily choices influence the aging process.

To the surprise of many, our bodies slowly decline starting in our 30s and 40s, with each organ and tissue losing about 1% per year. Most of us don’t notice the decline until it’s too late – after we fall and break a bone, or forget where the car is parked,” says Dr. Schimpff.  “But we have the power to change that if we modify our lifestyle. The critical question is, ‘Will each of us accept and follow the advice on eating, moving, managing stress, sleeping, not smoking, and being intellectually challenged and socially engaged?’” 

Unfortunately, the American healthcare delivery system focuses on disease, not wellness. The good news is however old you are, paying attention to these seven actions will slow the aging process, reduce chronic diseases, and result in a longer life with better health.

E. Albert Reece, MD, Dean of the University of Maryland School of Medicine, says of the book, “As the world's older population continues to expand at an unprecedented rate, Dr. Schimpff gives readers simple steps that can lay the crucial groundwork for our future health. He provides a refreshing perspective that our 'golden years' can also be our 'golden age,' based on his first-hand experience as a physician.”
In his fifth decade as a physician, educator, cancer and infectious disease researcher, academic medical center executive and author, Dr. Schimpff is one of the world's foremost experts on healthcare. A professor of medicine and former professor of public policy at the University of Maryland, he is also a senior advisor to  Sage Growth Partners and Sanovas, Inc. and is internationally recognized for his cancer and infectious disease research at the National Cancer Institute's Baltimore Cancer Research Center and the University of Maryland Marlene and Stewart Greenebaum Comprehensive Cancer Center. Board certified in internal medicine, infectious diseases, and medical oncology, and recently inducted as a Master in the American College of Physicians, he has published more than 200 scientific articles, reviews, and editorials, and has edited major textbooks on cancer, infectious diseases, and healthcare. This is his sixth book for a general audience.
Dr. Schimpff is a graduate of Rutgers University where he was a Henry Rutgers Scholar. He obtained his medical degree from Yale Medical School, where he was inducted into the Alpha Omega Alpha national honor medical society. 

Other Reviews

“In this easy-to-understand, yet frank and direct treatise intended for both patients and physicians, Dr. Schimpff successfully demystifies human longevity and its relationship to genetics and related environmental factors… The ‘keys’ to a long healthy life revealed by Dr. Schimpff make it a must-read for people young and old.” – Guru Ramanathan PhD, Chief Innovation Officer, GNC

“Dr. Schimpff explores the exciting topic of healthy aging. He combines the science of aging with evidence to suggest how each of us influences our personal journey in life.  We make choices everyday which impact our health. This book will help you understand how those daily choices will influence your life not only today but as you get older. Begin today to plan for tomorrow.” – James Anders, Jr, CPA, Chairman of the Board, National Senior Campuses, Inc.

“A highly enjoyable and uplifting read written by a physician with uncommon intellect and wisdom. Certainly, we can all benefit from following Dr. Schimpff's prescription for a healthier and more meaningful life.” – R. Alan Butler, CEO, Erickson Living, and board member, University of Maryland Medical System

For more information or to purchase “Longevity Decoded – the Seven Keys to Healthy Aging”, visit Amazon

Saturday, April 21, 2018

Live Longer - Live Healthier at No Cost

I am pleased and excited to tell you that my latest book, 

Longevity Decoded – The 7 Keys to Healthy Living

has just been published and is available on Amazon. If you are a bit intrigued, read further.

A few years ago I was asked to give a talk about the aging process to a group of people contemplating moving to a retirement community. Expecting a dozen or so, I was delightfully surprised at the turnover of over 100, a group that asked many questions at the end.  Then asked to do it again and in another venue, I felt that with this level of interest it would be worth while to write a book. For the past 2 ½ years I have interviewed experts, listened to lectures, done a lot of reading and then developed the book. Here is a summary

There is an inexorable process that begins in early adulthood in which every bodily function begins to decline at about 1% per year (with great variation from organ to organ, year to year and person to person.) Unnoticed at first, the decline eventually reaches a state where that organ’s function is impaired for daily living. For example, bone strength declines creating osteoporosis with the chance for bone fracture; cognitive decline leads to memory loss and muscle decline leads to loss of strength.  Meanwhile, as aging progresses the risk for developing complex chronic illnesses such as coronary artery disease, cancer, rheumatoid arthritis or Alzheimer’s disease accelerates.

The aging process cannot be stopped and diseases cannot be entirely prevented but with modifications of lifestyles, the rate of decline can be significantly slowed and the risk of developing a chronic illness can be greatly reduced. The result will be a longer healthier life.

You can live a long and healthy life. There is no magic pill, injection, elixir or Fountain of Youth, but you can achieve it with simple lifestyle modifications: 

1.       Eating the right foods
2.       Getting the right exercise
3.       Reducing and managing stress
4.       Improving the quality of sleep
5.       Eliminating tobacco
6.       Remaining intellectually engaged
7.       Staying involved socially

The advice in Longevity Decoded - The 7 Keys to Healthy Aging works— because it has stood the test of time and because it puts you in charge of shaping your future. There is no monetary cost but it is a rigorous program that is admittedly difficult for many to implement fully.

Everyone wants to live a long and healthy life—Longevity Decoded is your roadmap.  The “seven keys” cost nothing, except your time and commitment.  I offer  you straightforward advice for achieving and maintaining good health over a long life.  Following the “seven keys” will pay generous returns over the years ahead, and there’s a bonus:  You’ll become a role model and inspiration to your children and grandchildren! Indeed, they can benefit the most by following the “7 keys” because, like saving for retirement, the benefits compound over time.

Should you decide to take a look and read the book, I would be most appreciative if you would leave a 2-3 sentence review on Amazon. Potential readers read those reviews and it impacts Amazon’s search algorithm. And tell your friends and colleagues; that's the best possible book marketing. Many thanks.

Tuesday, August 1, 2017

Inadequate Communication Between Hospitalist and PCP is Detrimental To Patient Care

The American health care delivery system is reaching a point of crisis.  Its costs are escalating as outcomes and quality of care are diminishing.  It focuses on crisis management and treating problems aggressively with medicines and interventions of uncertain benefit, while neglecting true health and wellness.  It is estimated that 1 trillion dollars annually is being spent on unnecessary care, much of which occurs in the hospital, and some of which leads to harm. Medicare, although concerned about rising health care costs, does little to address the real issues and actually but subtly encourages aggressive management when less could indeed be more.  Hospital acquired infections and death from medical errors are far too numerous, often occurring in patients who did not have to be hospitalized in the first place.  Patients and physicians are frustrated, while private insurers and both Medicare and Medicaid are becoming unable to fund this excessively costly care without raising premiums or exhausting trust funds.  Something certainly must be done.

We wish to focus on one glaring problem occurring in hospitals that is relatively easy to fix and whose resolution could improve outcomes.  Currently, as many hospitals close their doors to primary care physicians (PCPs) and instead rely on hospitalists, there often is a lack of communication between these doctors that can lead directly to costly mistreatment.  A true and common story will set the stage.

Mrs. P suffers from dementia and lives in a nursing home.   One day she became unresponsive.  The nurse on duty could find no obvious reason and so immediately called 911 and sent her to the hospital.  While she quickly woke up, the emergency medicine physician admitted her for further evaluation.  Her assigned hospitalist found bacteria in the urine and treated her for a urinary tract infection, calling in an infectious disease consultation and starting her on a potent intravenous antibiotic.  He also requested consultations from a cardiologist and a neurologist to determine the cause of her unresponsiveness, and they ordered further tests including an MRI and an echocardiogram.  Mrs. P became more confused, was exposed to aggressive evaluation and treatment, and was losing her strength as a result of bed confinement.  She was ultimately sent back to her facility after tens of thousands of dollars of medical care, worse off than when she arrived.  She was fortunate to have not suffered further harm from her hospital-induced delirium and the potent medicines she received.

Let’s dissect what happened, and why.

The emergency medicine physician was faced with a lethargic person who could not give a coherent history, hence she was subjected to an extensive work-up and then admitted to the hospital. The hospitalist, likewise, was faced with a patient he had never met before, with only the emergency room records as guidance. He detected neurologic, infectious, and cardiac problems and so called for specialist consultations and extensive testing. 

It is unfortunate that the nursing home nurse did not call the patient’s primary care physician (PCP) upon transfer, but it was even more unfortunate that her PCP was not contacted at any time during her emergency room stay or subsequent hospitalization by any of the doctors who saw her.  Had they called Mrs. P’s PCP they would have learned that she had a long history of progressive dementia and similar unresponsive episodes in the past that had been fully evaluated. Further, they would have learned that she always carried bacteria in her urine without tissue invasion and that she could have received any of her treatments in the nursing home where she would have been safer and more comfortable, at a far lower cost.  A recent study showed that 20% of hospitalized patients who receive antibiotics develop an adverse event so avoiding unnecessary antibiotics must be a top priority.

The growth of the hospitalist movement over the past twenty years has been truly phenomenal – at 50,000 physicians it is the largest medical sub specialty, surpassed as a specialty only by general internal medicine at 109,000 and family medicine at 107,000. Studies suggested that quality was improved and costs reduced with hospitalist care. This was especially true for complicated patients who required multiple physician visits and interactions each day, something increasingly difficult for the community based PCP to achieve.

The hospitalist is experienced in managing the types of medical issues that lead to hospitalization and works full time in the hospital. As a result they come to know how to “get things done” and potentially can give more efficient care. But they are far too often burdened with large numbers of patients, and often know very little about the patients they are treating. With too many patients to care for and too little information they tend to request consultations for problems that, given adequate time, they could have managed. This is especially problematic if the patient has multiple medical issues and is elderly. Other reasonable concerns are the diminishment of the patient-physician relationship and miscommunication and discoordination at both admission and discharge.  Communication with the patient’s PCP however could alleviate many of these issues.

PCPs have been – generally – content to allow the hospitalist to manage their patients, indeed it has been a major advantage for many. PCPs have seen their overhead costs rise dramatically, necessitating seeing more and more patients per day for less and less time each in order to cover those overhead costs. The multitude of rules, regulations and requirements foisted upon them by the insurers has further consumed extensive time, time that previously could be used to care for their hospitalized patients. Today, many PCPs do not have time to see patients in the hospital, while others are barred from doing so by hospital rules. 

In this situation, both PCPs and hospitalists could have improved Mrs. P’s care substantially, and reduced the cost of unnecessary care, simply by communicating.  A call or text by the hospitalist to the PCP upon admission and at various decision points might have enabled Mrs. P to leave the hospital before any consults were called, before extraneous tests were ordered, before antibiotics were initiated, and before she became more confused and weaker.  More than half of elderly patients leave the hospital worse off than when they came in, and involvement of a PCP in a patient’s care could potentially facilitate more rapid discharge and less aggressive treatment. 

A recent survey indicated that 95% of hospital leaders are concerned that discharge communication is “inefficient” and 80% have concerns about communication among care team members.  PCPs complain that they are never called. Hospitalists often state that they just don’t have time to call the PCP but when they do, the PCP is not available. Each is culpable. Each must remember that the issue at hand is the patient’s care and welfare, not their convenience or preferences. It is a matter of professional responsibility. What could help? The electronic medical record was supposed to solve these sorts of problems but it has not and probably will not in the foreseeable future. There are some HIPPA compliant texting systems which could be utilized and there are HIPPA compliant smart phone apps that can coordinate among all involved physicians, nurses, hospitals, other facilities and even the patient him or herself. One of these types of systems could potentially negate the issue of non-availability although it will not top the value of nuanced conversation among physicians. 

In the end, there is nothing that trumps good physician to physician communication. It must be incumbent on hospitalists to involve PCPs during in-patient stays and it must be incumbent on PCPs to respond to hospitalists and provide crucial insight and information when asked to do so.   Not only can outcomes be improved, but costs can drop and patients and their families can feel more comfortable knowing that their own doctor is involved in their care.  If necessary, hospitals should set policy that makes hospitalist to PCP communication mandatory; everyone will benefit.  Very basic solutions can frequently lead to profound improvement. 
This post was co-authored by 
Andy Lazris, MD, CMD  a primary care physician whose private practice focuses on geriatric patients especially those residing in long term care and assisted living facilities. He is the author of Curing Medicare and co-author of Interpreting Health Risks and Benefits and was first published on Medical Economics on July 29, 2017

Praise for Dr Schimpff

The craft of science writing requires skills that are arguably the most underestimated and misunderstood in the media world. Dumbing down all too often gets mistaken for clarity. Showmanship frequently masks a poor presentation of scientific issues. Factoids are paraded in lieu of ideas. Answers are marketed at the expense of searching questions. By contrast, Steve Schimpff provides a fine combination of enlightenment and reading satisfaction. As a medical scientist he brings his readers encyclopedic knowledge of his subject. As a teacher and as a medical ambassador to other disciplines he's learned how to explain medical breakthroughs without unnecessary jargon. As an advisor to policymakers he's acquired the knack of cutting directly to the practical effects, showing how advances in medical science affect the big lifestyle and economic questions that concern us all. But Schimpff's greatest strength as a writer is that he's a physician through and through, caring above all for the person. His engaging conversational style, insights and fascinating treasury of cutting-edge information leave both lay readers and medical professionals turning his pages. In his hands the impact of new medical technologies and discoveries becomes an engrossing story about what lies ahead for us in the 21st century: as healthy people, as patients of all ages, as children, as parents, as taxpayers, as both consumers and providers of health services. There can be few greater stories than the adventure of what awaits our minds, bodies, budgets, lifespans and societies as new technologies change our world. Schimpff tells it with passion, vision, sweep, intelligence and an urgency that none of us can ignore.

-- N.J. Slabbert, science writer, co-author of Innovation, The Key to Prosperity: Technology & America's Role in the 21st Century Global Economy (with Aris Melissaratos, director of technology enterprise at the John Hopkins University).