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Health
Internet resources for what you need to know about NYC Health
Five Favorite Sites For Beginners

The Topic
"Health" refers to the health issues facing the city, touching on everything from the mayor to Medicaid to managed care to mosquitoes.
The Context
New York City is one of the biggest public health challenges in the world. With 7 million residents--over 1 million of whom are uninsured--the city has the largest number of HIV cases and the largest number of intravenous drug users in the U.S. Efforts to contain a tuberculosis outbreak that threatened the city in the 1990's have been a major success--between 1992 and 1998, the deadly multi-drug resistant cases of TB declined by over 90 percent.

New York City has 20 public hospitals which served 1.5 million people in 1998 alone. Run by New York City's public Health and Hospitals Corporation, the hospital system now has a surplus of $21 million, following years of deficits and cutbacks.

The Reporter
Maia Szalavitz is author, with Dr. Joseph Volpicelli, of "Recovery Options: The Complete Guide: How You and Your Loved Ones Can Understand and Treat Alcohol and Other Drug Problems." She writes frequently on health, science and public policy for the New York Times, New York Magazine, the Village Voice, and other publications.

by Maia Szalavitz

Mental Health Research

(nov '01) Some good news in these bad times: Researchers are getting a better grasp on mental illness. That was the clear conclusion of the National Association for Research on Schizophrenia and Depression (the second largest funder of mental health research after the National Institutes of Health), which held its thirteenth annual scientific symposium at the penthouse of the Parker Meridien Hotel, high above Manhattan's streets.

There, researchers presented information about their on-going studies, which are aimed at curing mental illnesses. Unlike other disorders, these can upset not only daily life and activity, but people's inner sense of self and will.

Listening to these researchers -- who are applying reason, technology and passion to helping humanity -- was a great tonic for dozens of New Yorkers recently exposed to acts of destruction and terror. Here are just some of the advances that were reported at the meeting:

THE ODDS OF BEING NORMAL

One key topic of discussion was how events in brain development -- that take place in a mother's womb or during childhood-- may lead to some of the problems seen in brain diseases like schizophrenia.

"The child is father to the man," said commentator Patricia Goldman-Rakic, a professor of neurobiology at Yale University. "Everything that we are, was set in motion at the time of insemination. It's fascinating -- and one of the most robust areas of neuroscience. Obviously, we won't understand what goes wrong until we understand normal development, which involves hundreds of thousands of proteins which are expressed at different points in development."

As the researchers each discussed their work seeking to understand even a minuscule portion of this exquisitely choreographed dance, the sheer complexity was dazzling. It seemed improbable that normal development could ever occur, given the enormous number of opportunities for errors and missteps. But normal is actually the most common outcome, of course.

ON SCHIZOPHRENIA

Dr. Steven Arnold, Associate Professor of Psychiatry and Neurology at the University of Pennsylvania, is using a unique window on neural growth to understand schizophrenia. Evidence is adding up that this disease is caused by problems in fetal brain development. Arnold is studying nerve cells (neurons) from the nose, which are amongst the few known to develop and change in humans not just in infancy, but throughout life.

"The olfactory system is also interesting because in clinical research we find that many patients with schizophrenia have an impaired sense of smell," says Arnold. The study he presented found significant differences between schizophrenics and normal people in these neurons. The people with schizophrenia had a much higher number of immature cells and the number of mature connections between cells was decreased.

Understanding what goes wrong as these neurons grow in adult schizophrenics may give important clues as to what goes wrong in neural growth in fetuses which will grow up to contract the disease.

HOW ANTIDEPRESSANTS WORK

Dr. Hari Manev, Associate Professor of Psychiatry at the University of Illinois, presented research adding to the accumulating evidence that antidepressants may work by stimulating neural growth. Scientists have found that all effective antidepressants (including electroconvulsive therapy) take several weeks to kick in -- and that they increase nerve growth factors (at least in rats) in an area of the brain known as the hippocampus. This area is key to memory formation, which can be disrupted in depression.

Other evidence shows that an over-active stress hormone system can kill or injure cells in the same area. Since stress can lead to depression, it would make sense that effective treatment might undo damage known to be linked to stress. And if neural growth is needed to resolve this damage, it would make sense that therapy takes weeks to work because nerves take time to grow.

STRESS, DEPRESSION AND HEART DISEASE

Laura Redwine, a postdoctoral fellow at the University of California-San Diego, studies the connections between stress, depression and heart disease. Researchers have long noted an association between congestive heart failure and depression -- and studies find that patients who undergo surgery for heart failure have a much worse prognosis if they are depressed. Redwine is looking at how an immune system chemical called interleukin-6 may link these problems.

IL-6 levels are elevated in congestive heart failure -- and if you administer the substance to normal subjects, they feel helpless, which is an important symptom of depression. The more helpless these heart patients feel, the less likely they are to be able to walk for six minutes-- and those who can't walk that long or longer are less likely to recover from their heart problem. Redwine found that when IL-6 levels were elevated and heart patients felt hopeless, they were unable to complete the walking task and this predicted future problems. Patients who felt helpless but did not have elevated IL-6 were not at greater risk.

What this means is that IL-6 may be one of the chemicals that links heart disease and depression -- and that dealing with the immune system connection might lead to better treatments for both conditions. In fact, a recent study found that treatment of depression with medications dramatically reduced the risk of heart disease, giving further weight to these connections.

There were twelve other presentations at the two-day symposium, all showing advances in neuroscience that are rapidly changing the way we view mental illness and that are leading to the development of more effective medications. Now, if only they could develop a drug or treatment to cure irrationality and hatred.


Maia's Favorite Five Sites For Beginners:

  • New York City Department of Health - Includes health alerts (including West Nile info), information on restaurant sanitary conditions and information on various health-promotion programs.
  • New York State Department of Health - More health data for New Yorkers including information on how to sign up for Child Health Plus and Family Health Plus-- the insurance programs for those who are presently not covered by other plans.
  • Medscape - This site, aimed at doctors, allows you to search Medline, the database of medical journals, for free. Abstracts of most journal articles are available for free as well. Once you have some basic knowledge about a condition you are researching, you can look here to get a sense of what is going on in terms of study in the area. There is a companion consumer-focused site, CBSHealthWatch, which is linked.
  • American Cancer Society - Half of all Americans will face cancer at some point in their lives-- and the New York and Washington-based American Cancer Society web site provides a wealth of information for those dealing with the disease. Includes links to other major cancer sites and resources.
  • AIDS Information - A sort of "AIDS central" for New York city with links to major HIV/AIDS organizations and information sites.


Other Recommendations:

  • Quackwatch - Debunks medical scams and inflated claims made by "alternative" medical practitioners.
  • AccentHealth.com - A consumer health information site, affiliated with CNN.
  • Citizen Action - Healthcare is one of the primary focuses of this New York advocacy group. Includes information on New York's health plans for low income people lacking insurance.
  • Oncolink - An incredible research resource for cancer patients and others concerned about this disease.
  • National Alliance for the Mentally Ill - An organization of advocates for people with mental illness which includes information on treatment and support for various disorders like depression, bipolar disease and schizophrenia.
  • Insure Kids Now - Information on New York state's insurance program for poor kids and information on other state's policies, from the federal government and the governors' association.

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Gotham Gazette is published by Citizens Union Foundation and is made possible by support from the Robert Sterling Clark Foundation, the John S. and James L. Knight Foundation, the Altman Foundation,the Fund for the City of New York and donors to Citizens Union Foundation. Please consider supporting Citizens Union Foundation's public education programs. Critical early support to Gotham Gazette was provided by the Charles H. Revson Foundation, Rockefeller Brothers Fund and the Alfred P. Sloan Foundation.

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