Tomorrow (2.17.12) – Free lecture/Seminar at Temple University
Improving Health Outcomes among Head and Neck Cancer Patients
Carolyn Y. Fang, PhD Associate Professor and Co-Leader of the Cancer Prevention & Control Program Fox Chase Cancer Center 941 Ritter Annex (Public Health Conference Room) February 17, 12-1 pm
Studies of head and neck cancer patients have noted that the social environment may be associated with various cancer outcomes, including survival. To date, the potential mechanisms that may underlie such associations have not been well-studied in this population. This seminar will present data from our studies that highlight key pathways linking the social environment with biological processes that may impact cancer outcomes in this patient population. In addition, directions for future interventions designed to enhance survivorship will be discussed.
Sponsored by the Social & Behavioral Health Interventions (SBHI) lab and the Department of Public Health, Temple University
In the December 2011 edition of the American Journal of Public Health a 10 year study of Washington state’s comprehensive tobacco control intervention found that for $1 spent by the state, they saved $5 in hospitalization and treatment costs. Wonderful! What an incredible investment! 5:1 return!
Here is a graph illustrating when their program went into effect and the decline in % Adults who smoke in Washington state (compared to the national rate).
The program consisted of indoor smoking bans, tax increases on tobacco products, media campaigns, a tobacco quit line, and community and school programs, among other components. This state-based program was meant to serve as a model for other states. Well, it looks like they did a great job. In terms of public health programs and cost savings of $1:$5 is excellent. So what happened? Washington Governor Christine Gregoire and the state legislature cut nearly all the programs funding for fiscal year 2012. Wait, What?!
Why would you de-fund a state program that is saving the state millions of dollars? Instead of writing in a little spending on tobacco control, they are essentially writing in five times the spending in state health care costs. The only explanation I can think of is that the state is so hard up for cash in the short-term that they are willing to kick those unfettered health costs down the road (and basically allowing for increased human suffering over the coming years). And/Or, given the current attitudes towards decreasing the roles of government, it may be that some folks view government-run tobacco control as outside the appropriate scope of government. Since tobacco does cost governments so much money in terms of care, it seems to me that they do and should have the authority to control the impact that tobacco has on the monetary bottom line. The health protection aspect is another story, one that gets at the heart of the arguments about the role of government.
Clearly, there is a lot of work that needs to be done in terms of high-quality research that demonstrates the cost-savings and health-savings afforded by public health programs like tobacco control programs. There is also work that must be done to frame the issue as one that governments should and very much need to be involved in.
A new study of job performance indicates that beyond the Big 5 Personality traits (openness, conscientiousness, extraversion, agreeableness, and neuroticism) honesty and humility are unique predictors of job performance.
I came across the article today, just as I myself experienced the benefits of being humble and honest in a work situation. But a better example comes from some wisdom shared with by my friend Léo Walton:
Upon entering the Neuroscience PhD program at the University of Wisconsin Léo mentioned that at first he felt like he was expected to know everything. Soon he realized that he could contribute more and be more successful in the program by admitting what he DID NOT know (which certainly takes honesty and humility). He was able to receive more valuable feedback and job-related information. Those around you, peers and supervisors alike, when they have a clearer picture of where you are coming from, are more likely to provide information that is useful to you, meets you at your current level of understanding, allowing you to then do a better job and be more effective and targeted in your work.
I think this is an incredibly powerful personality trait, especially in fields where collaboration is required.
But, I would imagine that this attribute could be important in many areas of life besides work. For example, we are told that in our social and romantic relationships honesty is crucial. How true.
I think the take-away message from this article can be summed up nicely by this quote from Malcolm X; “Don’t be in a hurry to condemn because he doesn’t do what you do or think as you think or as fast. There was a time when you didn’t know what you know today.”
In other words, you can’t know everything, and admitting what you don’t know only puts you in a position to be more successful in the future.
A recent study from researchers at the UCLA Cousin’s Center for Psychoneuroimmunology revealed a connection between brain activity in the regions that respond to stress and anxiety in social situations and inflammatory immune responses. This lends support to the mind-body (psychology-physiology) connection in the exacerbation of diseases like asthma, cardiovascular disease, cancer, and depression. I was excited to blog about these findings because they are relevant to my ongoing research “Life Stress, Social Problem Solving and Asthma”.
Essentially, I am hypothesizing that asthma patients who can more effectively cope with and adapt to stressful life situations will have better control over their asthma and have a better quality of life. The pathways that I suggest in my model are behavioral (i.e. medication adherence, seeking follow-up care, environmental asthma management strategies, etc), psychological (i.e. more effective coping and problem solving results in less anxiety and stress) and biological (i.e. anxiety and stress are associated with changes in immunology/inflammation and airway physiology).
The findings of the UCLA researchers are looking at the biological pathways from a very direct angle; measuring brain activity and inflammation in concert. While these findings are interesting and support the mind-body connection on a new level, there is still something lacking in terms of payback. That is to say, even if we can understand the tendencies and mechanics of the mind-body connection what good will come of it?
Perhaps my training has skewed my perspective but I suggest that the good will come from psychology and the science of health behavior. We can teach people coping skills and encourage them to engage in more adaptive life strategies. This can change their perception of their abilities to cope, changing their experience of stress, improving their disease self-management and, as this study suggests, support balance in the immune system.
A study from my alma-mater, the University of Wisconsin-Madison, increases our understanding of depression and how it affects one’s ability to experience positive emotions. Up until more recently it was believed that the brains of depressed individuals exhibited an overall decrease in activity in the regions of the brain responsible for generating pleasure/reward/positive emotions. Using fMRI imaging the UW researchers found that the brains of depressed individuals actually exhibit the same initial levels of activity in positive/pleasure-generating brain regions. Instead they found differences in the ability to sustain positive emotions. While it is not immediately clear how these results will impact treatment, they do provide insight into the nature of depression.
In terms of pharmacological treatments, taking advantage of these findings will require more sophisticated drug actions. With regards to behavioral interventions, these findings might suggest that patients should be assisted in clarifying their medium to long-term goals. Additionally, psychological treatment may also focus more heavily on helping patients develop a more distributed happiness. Depressed individuals (and non-depressed, for that matter) ought to create a life in which they receive pleasure and reward from multiple areas of their life. This bottom-up (behavior to brain influence) approach is more likely to lead to long-term, enduring positive emotions. In general, this study lends support to notion that depression is best treated by psychological/behavioral treatments or in combination of drugs, not drugs alone.