Pharmaceutical companies often make up trade names for new drugs that semi-subliminally evoke their purpose - some of my favorites are Boniva, for osteoporosis, or Ambien, the sleeping pill that sounds like it was named by Brian Eno.  It’s kind of a silly practice, motivated mostly by marketing reasons, because all of these drugs already have names - Ambien’s true name, Zolpidem, is even kind of fun to say. But the fact that these trade names are so widespread suggests they are effective at attracting consumers, so here’s my modest proposal: let’s give simple changes in diet and exercise that improve health a fancy trade name, Lifestyltrin.

This train of thought stems from a study published last week by medical journal The Lancet, in which one of the largest diabetes studies showed (again) that changes in lifestyle are more effective than a leading medication in preventing the disease. Originally published in 2001, the Diabetes Prevention Program (DPP) followed more than 3000 people at risk for diabetes at hospitals across the United States as they underwent either a lifestyle intervention, treatment with anti-diabetic drug metformin, or a placebo treatment. After nearly 3 years of study, the authors reported that lifestyle changes (meaning diet and exercise to reduce weight) reduced diabetes incidence by almost 60%. Metformin also reduced the disease, but only by about 31% - results so strong that the authors stopped the study and began offering both treatments to everyone in their study.

But the study didn’t end, and the medical centers involved continued to monitor as many patients as were willing to stay in contact. All told, 2766 of the original 3234 participants continued to be monitored, allowing the publication last week of a followup study examining how many of these at-risk patients had developed diabetes 10 years after the original study began. What they found was somewhat status quo - after 10 years, the lifestyle group still showed twice the decrease of new diabetes cases than the drug group, 34% vs 18% lower compared to placebo. But that also means there was no difference in the number of new diabetes cases between lifestyle and drug groups in the 7 years between the original study’s end and the followup study’s end, which authors attributed to the mixture of treatments - the group receiving lifestyle interventions was now allowed access to metformin, and vice versa.

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The classic slogan for Lay’s potato chips is “Betcha’ can’t eat just one!,” and anyone who’s ever sat down with a new bag of chips and systematically worked their way down to the bottom of the bag in an almost hypnotic state knows the truth of that message. Portion size has been shown in many studies to be a contributor to overeating, as scientists find that people tend to eat the food that’s placed in front of them rather than stopping when their hunger is satisfied. Some might say this behavior is culturally programmed by millions of mothers telling children to “clean their plates” - a good strategy for broccoli, but a rather unhealthy one when faced with a heaping mound of french fries.

But there may also be a biological reason driving people to eat whatever amount of food is placed in front of them, to the detriment of their own personal health. Today in the Journal of Neuroscience, University of Chicago neurobiologists Hayley Foo and Peggy Mason publish experiments that indicate rats get into a zone while eating or drinking something they like that actually reduces their sensitivity to pain. While eating a chocolate chip or having sugar water or regular water infused into their mouths, rats are slower to move their feet away from a hot light-bulb than when they are not eating or drinking. The implication is that rats are so focused on finishing the food in front of them, they are less susceptible to distractions…such as, for instance, a hot foot.

“It’s a strong, strong effect, but it’s not about hunger or appetite,” Mason said. “If you have all this food in front of you that’s easily available to reach out and get, you’re not going to stop eating, for basically almost any reason.”

In the wild, where food is scarce, a resistance to distraction while eating is a good skill to have. If a wild rat is eating a hard-earned nut, it would rather ignore that mild pain in its foot rather than flee the scene and risk losing the nut to another hungry animal. But for humans in modern society, where the next meal is only as far as the nearest supermarket or McDonald’s, an unshakable focus on finishing the food in front of you and drowning out distractions (like a little voice inside your head reminding you how many calories you’re consuming in that Big Mac), is decidedly unhealthy.

“We’ve gotten a lot more overweight in last 100 to 150 years,” Mason said. “We’re not more hungry; the fact of the matter is that we eat more because food is readily available and we are biologically destined to eat what’s readily available.”

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Thanks to scientific and medical progress, the average life expectancy of a person in North America is 80 years and increasing. But in sub-Saharan Africa, the average lifespan is half that figure, and dropping. Technology is often said to have made the world a much smaller place, so how can those of us fortunate enough to be in the developed world help close that shocking life expectancy gap? That question, according to the University of Toronto’s Peter Singer, is “the mother of all ethical challenges.”

Singer, a professor of medicine and an internationally-renowned expert on bioethics, returned Wednesday to the University of Chicago, the school where he studied medical ethics 22 years ago. And boy did we put him to work, asking him to deliver the opening speeches for two separate but related launches: this year’s MacLean Center for Clinical Medical Ethics seminar series, and the school’s new Global Health Initiative. In both lectures, Singer drew from vast experience in facilitating efforts to improve health in Africa, India, China and other areas of the developing world, offering valuable advice for what doctors, scientists, and universities could do to help such efforts.

It’s nice to think that simply sending doctors and the fruits of scientific research to needy countries would solve these problems, but as Singer explained, there are several obstacles to merely hoping public health will spread around the globe by osmosis. Singer showed this Nature Review Immunology figure from 2002, which illustrates how developing countries lag behind in vaccinations given to children despite the development of vaccines for more diseases. Lack of scientific discovery relevant to the developing world, ethical and social barriers and a “brain drain” of scientific talent from Africa and Asia have all contributed to these inequalities, Singer said.

But Singer also gave reasons for optimism. In 2003, The Bill and Melinda Gates Foundation (for which Singer serves as an advisor), issued their Grand Challenges in Global Health, funding vaccine research and efforts to limit diseases spread by insects - scientific questions more pressing to to poor countries. Six years later, those projects are already bearing fruit, such as the effort to infuse staple crops of poor populations with nutrients, the creation of genetically modified mosquitos that don’t spread malaria or the combination of several vaccines into a single injection. 

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Convincing people to stop smoking is no easy task, as family members or friends of smokers know all too well. But consider a situation where roughly three-quarters of active smokers find themselves ready to quit, willing to make that all-important first step of deciding to go smoke-free. When is this short window of vulnerability and motivation open? The time is when a smoker is in the hospital, said Dr. Lisa Shah, instructor in the section of hospital medicine at the University of Chicago Medical Center, a time when the patient is also surrounded by the infrastructure needed to nurture a desire to stop smoking into a successful change of behavior.

But Shah, a researcher focused on studying inpatient tobacco cessation, said in her Medicine Grand Rounds presentation Tuesday afternoon that many doctors miss this opportunity to help their patients kick a dangerous habit. In fact, it was right there on a slide titled The Missed Opportunity, which laid out why inpatients find themselves ready to quit: the no-smoking policies in place at hospitals*, the shock of being hospitalized for an illness that may be a direct result of smoking, and the isolation from environmental cues at home or work that may trigger the urge to smoke.

“For the smokers we see here, often one big barrier to quitting smoking is that they have family members and friends who also smoke cigarettes, Shah said. “Social smoking is a huge impetus to smoke, and makes it hard to quit. So hospitalization helps them succeed in quitting smoking without the temptation.”

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Whether you call it pop, soda, a soft drink or lower-case coke, sugary, carbonated beverages have become a staple of the American diet. And as we all know, the American diet is not exactly the healthiest. So with obesity racking up an estimated $150 billion a year in health care costs - which, as you may have heard, is in the news lately - some researchers have considered whether Coke, Pepsi and their sucrose-packed brethren should be subject so the same type of “sin tax” that has been applied in the past to alcohol and tobacco by some governments.

Here in ScienceLife’s home state of Illinois, carbonated soft drinks (as well as most candy) were recently reclassified from being considered as food to “general merchandise” - a seemingly innocuous change that actually means a sales tax increase from 2.25 percent to 10.25 percent in Chicago. In Illinois, the switch was justified as a way to generate much-needed revenue for state services, but could it also have a direct public health benefit by discouraging people, particularly children and teenagers, from drinking hundreds of calories in soda pop each day?

In this week’s New England Journal of Medicine, seven public health experts assess the best methods of improving public health through taxation of soft drinks. Soda is already taxed in 33 states, according to the article, at an average of 5.2%. But research indicates that those taxes have only marginal effects on soda consumption and obesity. One recent study out of UIC found only “weakly significant” effects of tax rate on the body mass index of children “at risk” of being overweight. In NEJM, the authors immediately state that the current tax rates are too small to have an effect on consumption - after all, a 5% tax on a 75-cent can of Coke is less than 4 cents, hardly enough to get someone to switch to water.

But the authors go on to suggest different methods of taxation that could be more effective in motivating people to change their beverage behavior. Rather than imposing an increased sales tax on all soda purchases, the authors suggest a tax of 1 cent per ounce on beverages with “added caloric sweetener” - your standard sugary Coke or Pepsi, but not your Nutrasweet-infused Diet versions. So a 12 oz. can of soda would set you back 12 cents, and a convenience-store fountain drink behemoth would cost almost a dollar extra, but if you opt for the diet version, no tax. Thus, the authors hope the tax will encourage (or financially push) consumers to make healthier decisions rather than merely opting for cheaper sugary drinks.

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