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Yes, Ringo Starr just turned 85. Let that sink in. I read this in the Washington Post and felt like a bag of Beatles vinyl had walloped me. How is this possible? How can the mop-top drummer be 85 when I was dancing to “Yellow Submarine” in bell-bottoms with a brush for a microphone? More urgently: how old does this make me?! Ringo isn’t slowing down. He’s still touring with two bands, making music, flashing that cheeky Liverpudlian smile, and preaching peace and love as if he’s got nowhere else to be. No plans to retire. No plans to fade away. Just a rockstar with a great attitude... and maybe a titanium hip (unconfirmed). This made me realize that, as the birthday candles on my cake now need a fire permit, “attitude” plays a huge role in how we age. Based on the feedback I received from my last post, “What’s Your Brand, Boomer?”, it’s clear that many people are genuinely interested in managing their personal brand as they age. This week, I want to go deeper—because whether you’re 45 or 85, you are Old People in Training. That’s right. Every one of us is aging in real-time, and understanding the stages ahead—either for ourselves or our aging loved ones—helps us walk this path with humour, grace, and fewer surprises. So, here they are: The 8 (Unofficial but Uncannily Accurate) Stages of Aging 1. The Stand-Up-and-Forget-Why Stage (Kicks in around mid-to-late 50s) You walk into a room with purpose, then wonder: was I here to fold laundry, pay a bill, or practice my slow blink? Bonus points if you’re already wearing the glasses you’re hunting for. How it helps: Eases forgetfulness. It’s not early dementia; it’s early distraction. Keep a notebook or use Voice Memos. Or do what I do: shrug, laugh, and keep walking until something jogs the memory (usually coffee). 2. The “Senior? Not Unless There’s a Discount” Stage (Hits in your early 60s) You bristle at the word “senior,” unless it saves you $2.50 at the movies or 15% at Shoppers. Suddenly, age becomes a tool, not a label. How it helps: Celebrate the advantages! You’ve earned them. And remember: owning your age is the new anti-aging remedy. Confidence looks good on everyone. Remember, you are still that age, whether you admit it or not. You might as well save some money! 3. The “Yes, I Really Am That Age” Reminder Stage (Kicks in around 65) You find yourself saying your age out loud like it’s a riddle. "I’m 65. Sixty-five! Isn’t that wild?" You’re still trying to catch up with the numbers, or maybe you’re worried you’ll forget your age. How it helps: Accept the number without letting it define you. It’s not a limit — it’s a launchpad. Bonus: Use it as an excuse to do something you’ve always put off. 4. The Replacement Parts Stage (Hits in the early to mid-70s) Welcome to orthopedic roulette: knees, hips, maybe a shoulder. You collect joint replacements like frequent-flyer miles. Fortunately, modern medicine allows for joint replacements to be performed more quickly than ordering takeout. Still waiting for Staples to offer 3D-printed hips. How it helps: Embrace science instead of fighting it. Biology always prevails! Mobility equals independence. And nothing embodies “active aging” like beating your grandkids at pickleball with a shiny new titanium knee. 5. The “I’ve Run Out of F*cks to Give” Stage (Kicked in the late 70s into the early 80’s) You’ve earned the right to speak your mind—and wear socks with sandals. You say what you want, mean what you say, and anyone who doesn’t like it can take a number. Opinions? Too many! Filters? Deleted. Freedom? Glorious. Friends? Running for cover! How it helps: This is peak freedom. Use it wisely. Advocate, participate, mentor, and model what unapologetic living looks like. You’re the elder statesperson now—be bold, not bitter. 6. The Cataract Conspiracy Stage (Kicks in mid-to-late 70s) Lights appear like halos, and reading menus becomes an Olympic event. But don’t worry—cataract surgery is so common it’s practically an oil change. And voilà: brighter colours, more precise lines, less squinting. Spoiler Alert: You will now be able to see how poor your housekeeping skills are! How it helps: Get your eyes checked. Don’t delay. Seeing clearly again can literally brighten your outlook—and maybe even your attitude. 7. The “Say What?” Stage – The Hard-of-Hearing Stage (Late 70’s+) This one sneaks up like a whisper… which is ironic, because you probably won’t hear it. At some point, for most of us, hearing begins to decline like old payphones and eight-track tapes. It might start with missing parts of conversations in noisy restaurants or asking people to repeat themselves (just once… or five times). Eventually, it’s full-blown “Say what?” territory. Many avoid wearing hearing aids because—let’s face it—they feel like a flashing neon sign that says, "I’m old!" But here’s the real issue: pretending to hear is much worse. It can lead to social withdrawal, isolation, and even strained relationships. And we’re not just making this up for dramatic effect—studies at John Hopkins School of Medicine show that untreated hearing loss is linked to a higher risk of dementia, depression, and cognitive decline. There’s also the loud TV effect—when your neighbours across the street can hear your Netflix queue, it’s time to see an audiologist, not to mention the safety concern: driving with impaired hearing is risky; sirens, honking horns, or even a warning from a passenger might go unnoticed. So, if your “What?” count is rising and your TV volume is climbing towards aircraft-engine decibels, take action. Getting your hearing tested doesn’t mean you’re old—it means you’re informed (and honestly, more enjoyable to be around). Because nothing celebrates “vibrant aging” more than staying connected to the world—and actually hearing it. Stage 8: The Long Goodbye – When Friends Start to Leave the Stage I’ve heard from seniors about Stage 8… and without exception, they say it’s one of the toughest parts of aging. This is the stage when the long goodbye starts—quietly at first, then with increasingly frequent moments. Your phone rings less often. The chairs at the coffee group gradually empty. One day, you realize you’re not just losing friends—you’re outliving them. It’s part of the circle of life, for sure—but no Lion King soundtrack can ease the heartbreak. This stage exposes some of our deepest fears: Will I be next? Who will mourn me? Does anyone even know I’m still here? It’s a time of grief, loneliness, and silent despair. And while you can’t fast-forward through it, you don’t have to walk it alone. If you’re an “Old Person in Training” (which, reminder: we all are), listen up. This stage isn’t just something that happens to others—it’s your future self, waving from down the road. Learning about it now prepares you to guide others through it with grace and to soften your own landing when the time arrives. And if someone you love is already there? This is your cue. Show up. Don’t wait to be invited—grief rarely sends formal RSVPs. Phrases or clichés like “they’re in a better place” won’t suffice here. These are nothing burgers—all bun, no meat—empty calories in a moment that needs nourishment. Show up. Stay steady. Be the evidence that they are still recognized, still cared for, still part of something meaningful. What they truly need is presence, not presents. Time, not timelines. They need to feel they are not alone. Sit with them. Walk with them. Watch Jeopardy in silence if that’s what the day calls for. But whatever you do, don’t disappear. Because one of the most profound gifts we can give in this stage isn’t a cure—it’s companionship. Science Confirms It: Attitude Is a Lifespan Strategy Tongue-in-cheek aside, these aging observations are backed by science: Positive beliefs about aging can extend life by 7–8.5 years. (Source: PubMed – Levy et al.) Optimism correlates with lower heart disease, stroke, and a 70% greater likelihood of reaching age 85. (Source: Harvard Health) Positive mindset boosts recovery, brain health, and resilience after illness. (Source: Harvard Health) So, what can we learn from Ringo? Keep creating – Music, art, businesses, bad poetry. It keeps the brain limber and the soul alight. Stay curious – Sign up for that course. Take the trip. Ask questions. Enrol in the MBA. (Looking at you, 69-year-old rockstars.) Lean into joy – Laugh like nobody’s judging. Dance like your knees aren’t watching. Surround yourself with good vibes – Optimism costs nothing and glows brighter than Botox. Remember, it’s not your age—it’s your outlook. So next time you stand up and forget why you did, just grin and say: ‘I’m aging like a Beatle. Still standing. Still grooving. Still fabulous.” And if you ever need a pep talk, ask yourself: “What would Ringo do?” Don’t’ Retire Re-wire Sue
AU research team awarded $4.4 million American Heart Association grant
A research team at Augusta University, led by Jennifer C. Sullivan, PhD, has secured a $4.4 million grant from the American Heart Association to study the risk factors for cardiovascular and kidney diseases and how they impact women. Sullivan’s research center, “Disruptions in cardiorenal free fatty acid metabolism in Cardiovascular Kidney Metabolic Syndrome,” is part of a larger $15 million project titled “Strategically Focused Research Network on Cardiovascular Kidney Metabolic Syndrome: Heterogeneity in Women.” The overarching AHA project is aimed at learning why women may be more likely to develop cardiovascular and kidney diseases due to certain unique risk factors and life stages. Research teams from Massachusetts General Hospital and The Ohio State University were also chosen. “I think this is a huge step for Augusta University as we continue to distinguish ourselves and the research that we have here focused on the health of women,” said Sullivan, dean of The Graduate School. “This grant is particularly impactful as we look to advance and improve the health of women, not just in Georgia, but for the entire country.” According to the Healthy Georgia Report, produced by AU’s School of Public Health, Georgia has the 23rd highest rate of obesity in the United States. Among the women living in the state, 38.3% of them, as well as 37.5% of people living in rural areas, suffer from obesity. “It’s great that we are able to represent the state of Georgia because our state has such a high prevalence for obesity rates,” said Sullivan, who is the director of AU’s SCORE project “Improving awareness of women with hypertension: ROAR (Rural, Obese, At Risk).” “It’s important for us to understand that different populations have distinct needs. You can’t talk about a one-size-fits-all approach to health. This is really about trying to understand how different groups are impacted.” Each center is comprised of three teams, as well as a training component and an area partner. Together, they will explore obesity’s lifetime impact on CKM syndrome through three projects. CKM syndrome is a clinical term that describes the combined health effects of heart disease, kidney disease, diabetes and obesity, which puts people at high risk for heart attack, stroke and heart failure. According to the American Heart Association’s 2025 Heart Disease and Stroke Statistics, about 1 in 3 U.S. adults has at least three components of CKM syndrome, which include high blood pressure, abnormal cholesterol, high blood glucose (sugar), impaired kidney function and excess body weight. The first project is led by Daria Ilatovskaya, PhD, and Justine Abais-Battad, PhD, and will look at aging and Western diet-induced CKMS mechanisms in obesity. Ilatovskaya is an associate professor and the graduate program director for the Doctor of Philosophy in Physiology program, and Abais-Battad is an assistant professor in the Department of Physiology with the Medical College of Georgia at Augusta University. The second component, led by Jessica Faulkner, PhD, an assistant professor in MCG’s Physiology department, will study obesity-associated mechanisms of CKMS in pregnancy. The third project, led by Stephen Coughlin, PhD, with Marlo Vernon, PhD, is looking at CKMS epidemiology, associations with obesity, CVD/CKD. Coughlin is the program director for the Master of Science in Epidemiology and professor of epidemiology in the School of Public Health’s Department of Biostatistics, Data Science, and Epidemiology, while Vernon is an associate professor with MCG’s Georgia Prevention Institute and SPH’s Department of Community and Behavioral Health Sciences. Additionally, the team will talk to women and health care providers from a variety of backgrounds and experiences to assess current knowledge and interest levels in heart health and use that information to develop programs that may help treat and prevent disease. There is also a training director, Alison Kriegel, PhD, a professor in the Department of Physiology, and a core director, Guido Verbeck, PhD, chair and professor of the Department of Chemistry and Biochemistry in the College of Science and Mathematics. “We have a strong blend of clinical epidemiology and basic science, as well as a training component, which we will fill with post-doctoral fellows,” Sullivan said. “Dr. Ilatovskaya, Dr. Faulkner, Dr. Abais-Battad and Dr. Vernon are all a part of our ROAR grant, and, while this isn’t directly related to that program, it allowed us to demonstrate how we are already well positioned to work together to amplify our ability and increase awareness about the importance of the health of women.” The team has over 50 collaborative papers and has secured more than $13 million in collaborative funding to advance the health of women. They also all have experience training fellows and students to continue to expand their reach. “We already have a lot of the infrastructure in place for this kind of cross-disciplinary project, so we leaned very heavily into our connections and the expertise we have here at Augusta University. It’s set up very similar to our ROAR program, so this is something that was really organic in nature,” Sullivan said. The American Heart Association has invested almost $300 million to establish 18 Strategically Focused Research Networks, each aimed at addressing a key strategic issue identified by the association’s volunteer Board of Directors. Prior networks have been studying a wide variety of important topics including, but not limited to, prevention, hypertension, the health of women, heart failure, obesity, vascular disease, atrial fibrillation, arrhythmias/sudden cardiac death, cardiometabolic health/type 2 diabetes, health technology, cardio-oncology, the biological impact of chronic psychosocial stress and the role of inflammation in cardiovascular health. Each network centers around scientific knowledge and knowledge gaps, prevention, diagnosis and treatment of the key research topic. Three to six research centers make up each network, bringing together investigators with expertise in basic, clinical and population/behavioral health science to find new ways to diagnose, treat and prevent heart disease and stroke. Funding scientific research and discovery through initiatives like these awards is a cornerstone of the century-old American Heart Association’s lifesaving mission. The association has now funded more than $5.9 billion in cardiovascular, cerebrovascular and brain health research since 1949, making it the single largest non-government supporter of heart and brain health research in the United States. New knowledge resulting from this funding continues to save lives and directly impact millions of people in every corner of the U.S. and around the world. Looking to know more about the amazing research happening at Augusta? To connect with Dr. Sullivan, simply click on her icon to arrange an interview today.
A New Heart Disease Prevention Strategy: Combining Ezetimibe & Statins
Statement by Kirk Garratt, M.D., Medical Director of ChristianaCare's Center for Heart & Vascular Health "A new study is challenging the current approach to preventing heart disease by showing that combining ezetimibe (Zetia) with statins could be a highly effective treatment for all high-risk patients, not just those who can’t tolerate higher doses of statins. Ezetimibe works by blocking the absorption of dietary fats before they reach the liver, while statins block the conversion of these fats into bad cholesterol. Clinical studies have already shown that combining moderate doses of statins with ezetimibe works as well as high doses of statins alone. This new research, which used a sophisticated method to combine results from many studies, demonstrates the potential of using this combination more routinely. The impact could be significant—potentially avoiding thousands of heart attacks and saving many lives each year. Ezetimibe has minimal side effects and is available in generic form, offering a treatment option with few barriers to widespread use. However, patients should speak with their doctor to discuss whether this combination is right for them." Learn more:
Annual Healthy Georgia Report looks at public health in the Peach State
The fourth edition of the “Healthy Georgia: Our State of Public Health” report has been released by the Institute of Public and Preventive Health in Augusta University’s School of Public Health. Within the 64 pages of the report is a snapshot of how healthy Georgians are compared to citizens across the 12 states that make up the Southeastern Region (Alabama, Arkansas, Florida, Georgia, Kentucky, Louisiana, Mississippi, North Carolina, South Carolina, Tennessee, Virginia and West Virginia) and the entire United States. The 2025 edition addresses 31 health topics and has been expanded this year to include multimorbidity; long COVID-19; HIV, chlamydia, gonorrhea and syphilis infection rates; opioid and methamphetamine drug use; suicides; and vaping. Biplab Datta, PhD, assistant professor in the Department of Health Management, Economics, and Policy in SPH, heads up the team of IPPH faculty and staff who create the report each year. Datta credits Jen Jaremski, research associate, and Kit Wooten, public health analyst, with handling much of the work of bringing the report to life. Together, Jaremski and Wooten collected and organized all of the needed assets and organized the 64-page document, preparing it for print and the web. “Every year we strive to present data in a way that policymakers may find helpful in making policy choices,” Datta said. “There are several new topics that were added to this year’s report and some of those are concerning for the state of Georgia, particularly the communicable diseases like HIV, chlamydia, gonorrhea and syphilis. High prevalence rates of these conditions in Georgia, compared to the rest of the U.S. and the Southeastern Region, warrant attention of the public health community.” Georgia has the second-highest rate of HIV infections in the U.S., fourth-highest rates of gonorrhea, sixth-highest for chlamydia and 13th for syphilis. Something that is also new in this year’s report is a comparison of numbers from 2019, or before the COVID-19 pandemic began, compared to after the pandemic for certain conditions. Also coming out of the pandemic, the report looks at how long COVID has affected Georgians, with the state ranking 24th in the nation for rates of long COVID. According to the U.S. Centers for Disease Control and Prevention, long COVID is defined as a chronic condition that occurs after COVID-19 infection and is present for at least three months. On top of looking at comparisons between Georgia and the Southeast and the nation, Datta noted a clearer picture is starting to emerge concerning the difference in urban and rural areas within the state. “For several chronic conditions, like hypertension, diabetes and multimorbidity, we clearly see a striking difference between rural and urban residents of Georgia,” Datta said. Hypertension affects 44.1% of adults in rural Georgia compared to 35% in urban areas, while diabetes affects 17.5% of adults in rural Georgia compared to 12.3% of those in urban areas. Hypertension and diabetes are major risk factors for cardiovascular disease, which affects 12.2% of adults in rural areas compared to 8.3% of adults in urban areas of Georgia. “Hypertension and diabetes are the major risk factors for heart disease, which is the leading cause of death in the U.S. and worldwide, so these are some concerning numbers to see,” Datta said. Multimorbidity, which is when a person has multiple chronic conditions, including obesity, asthma, chronic obstructive pulmonary disease, depression, kidney disease, diabetes, hypertension, high cholesterol, cardiovascular disease, cancer, skin cancer and arthritis, affects 57.4% of adults in rural Georgia compared to 49% of adults in urban areas of the state. These rates are significantly lower than the rest of the Southeast but on par with the rest of the country. When comparing Georgia to the U.S. national average, adults in Georgia have lower rates of cancer and methamphetamine use but higher rates of childhood asthma and adult obesity. At the same time, rates of adult asthma and adult obesity among Georgians were comparable to the averages seen in the Southeast. Interestingly, while adult health insurance coverage was significantly lower than the U.S. national and Southeast Regional averages, the child health insurance coverage in Georgia was comparable to both national and regional averages. The Healthy Georgia Report is the only report of its kind in the state Looking to know more or connect with Biplab Datta, PhD? Then let us help. Dr. Datta is available to speak with media regarding this important topic. Simply click on his icon now to arrange an interview today.
Expert Opinion - The Undisclosed Risks of Off-brand Ozempic and Other Weight Loss Products
The popularity -- and price -- of brand-name injectable drugs like Ozempic, Wegovy, Mounjaro, and Zepbound has skyrocketed. But the soaring demand for these drugs -- used for weight loss as well as to control blood sugar levels and reduce the risk of heart disease -- and the limited supply as well as lack of generic options has also led to a flood of non-brand alternatives in the market. In a recent article for The Conversation, UConn expert C. Michael White, Distinguished Professor of Pharmacy Practice, issued a warning to consumers about the potential undisclosed risks of these off-brand products: High demand is driving GLP-1 wannabes The dietary supplement market has sought to cash in on the GLP-1 demand with pills, teas, extracts and all manner of other products that claim to produce similar effects as the brand names at a much lower price. Products containing the herb berberine offer only a few pounds of weight loss, while many dietary supplement weight loss products contain stimulants such as sibutramine and laxatives such as phenolphthalein, which increase the risk of heart attacks, strokes and cancer. The role of compounding pharmacies Unlike the dietary supplements that are masquerading as GLP-1 weight loss products, compounding pharmacies can create custom versions of products that contain the same active ingredients as the real thing for patients who cannot use either brand or generic products for some reason. These pharmacies can also produce alternative versions of brand-name drugs when official drug shortages exist. Since the demand for GLP-1 medications has far outpaced the supply, compounding pharmacies are legally producing a variety of different semaglutide and tirzepatide products. These products may come in versions that differ from the brand-name companies, such as vials of powder that must be dissolved in liquid, or as tablets or nasal sprays. Just like the brand-name drugs, you must have a valid prescription to receive them. The prices range from $250-$400 a month – still a steep price for many consumers. Compounding pharmacies must adhere to the FDA’s sterility and quality production methods, but these rules are not as rigorous for compounding pharmacies as those for commercial manufacturers of generic drugs. In addition, the products compounding pharmacies create do not have to be tested in humans for safety or effectiveness like brand-name products do. Proper dosing can also be challenging with compounded forms of the drugs. Companies that work the system For people who cannot afford a compounding pharmacy product, or cannot get a valid prescription for semaglutide or tirzepatide, opportunistic companies are stepping in to fill the void. These include “peptide companies,” manufacturers that create non-FDA approved knockoff versions of the drugs. From November 2023 to March 2024, my team carried out a study to assess which of these peptide companies are selling semaglutide or tirzepatide products. We scoured the internet looking for these peptide companies and collected information about what they were selling and their sales practices. We found that peptide sellers use a loophole to sell these drugs. On their websites, the companies state that their drugs are for “research purposes only” or “not for human consumption,” but they do nothing to verify that the buyers are researchers or that the product is going to a research facility. By reading the comments sections of the company websites and the targeted ads on social media, it becomes clear that both buyers and sellers understand the charade. Unlike compounding pharmacies, these peptide sellers do not provide the supplies you need to dissolve and inject the drug, provide no instructions, and will usually not answer questions. Peptide sellers, since they allegedly are not selling to consumers, do not require a valid prescription and will sell consumers whatever quantity of drug they wish to purchase. Even if a person has an eating disorder such as anorexia nervosa, the companies will happily sell them a semaglutide or tirzepatide product without a prescription. The average prices of these peptide products range from $181-$203 per month. Skirting regulations Peptide sellers do not have to adhere to the rules or regulations that drug manufacturers or compounding pharmacies do. Many companies state that their products are 99% pure, but an independent investigation of three companies’ products from August 2023 to March 2024 found that the purity of the products were far less than promised. One product contained endotoxin – a toxic substance produced by bacteria – suggesting that it was contaminated with microbes. In addition, the products’ promised dosages were off by up 29% to 39%. Poor purity can cause patients to experience fever, chills, nausea, skin irritation, infections and low blood pressure. In this study, some companies never even shipped the drug, telling the buyers they needed to pay an additional fee to have the product clear customs. If a consumer is harmed by a poor-quality product, it would be difficult to sue the seller, since the products specifically say they are “not for human consumption.” Ultimately, consumers are being led to spend money on products that may never arrive, could cause an infection, might not have the correct dose, and contain no instructions on how to safely use or store the product. Dr. C. Michael White is an expert in the areas of comparative effectiveness and preventing adverse events from drugs, devices, dietary supplements, and illicit substances. Dr. White is available to speak with media -- click on his icon now to arrange an interview today.
Expert Insight: Training Innovative AI to Provide Expert Guidance on Prescription Medications
A new wave of medications meant to treat Type II diabetes is grabbing headlines around the world for their ability to help people lose a significant amount of weight. They are called GLP-1 receptor agonists. By mimicking a glucagon-like peptide (GLP) naturally released by the body during digestion, they not only lower blood sugar but also slow digestion and increase the sense of fullness after eating. The two big names in GLP-1 agonists are Ozempic and Wegovy, and both are a form of semaglutide. Another medication, tirzepatide, is sold as Mounjaro and Zepbound. It is also a glucose-dependent insulinotropic polypeptide (GIP) agonist as well as GLP-1. Physicians have been prescribing semaglutide and tirzepatide with increasing frequency. However, both medications come with a host of side effects, including nausea and stomach pain, and are not suitable for every patient. Many clinics and physicians do not have immediate access to expert second opinions, as do the physicians at Emory Healthcare. Creating a Digital Twin That lack of an expert is one of the reasons Karl Kuhnert, professor in the practice of organization and management at Emory University’s Goizueta Business School, is using artificial intelligence to capture the expertise of physicians like Caroline Collins MD through the Tacit Object Modeler™, or TOM. By using TOM, developed by Merlynn Intelligence Technologies, Kuhnert and Collins can create her “decision-making digital twin.” This allows Collins to reveal her expertise as a primary care physician with Emory Healthcare and an Assistant Professor at Emory School of Medicine, where she has been leading the field in integrating lifestyle medicine into clinical practices and education. Traditional AI, like ChatGPT, uses massive amount of data points to predict outcomes using what’s known as explicit knowledge. But it isn’t necessarily learning as it goes. According to Kuhnert, TOM has been designed to learn how an expert, like Collins, decides whether or not to prescribe a drug like semaglutide to a patient. Wisdom or tacit knowledge is intuitive and rooted in experience and context. It is hard to communicate, and usually resides only in the expert’s mind. TOM’s ability to “peek into the expert’s mind makes it a compelling technology for accessing wisdom.” “Objective or explicit knowledge is known and can be shared with others,” says Kuhnert. "For example, ChatGPT uses explicit knowledge in its answers. It’s not creating something new. It may be new to you as you read it, but somebody, somewhere, before you, has created it. It’s understood as coming from some source." Karl Kuhnert “Tacit knowledge is subjective wisdom. Experts offer this, and we use their tacit know-how, their implicit knowledge, to make their decisions. If it were objective, everyone could do it. This is why we hire experts: They see things and know things others don’t; they see around corners.” Mimicking the Mind of a Medical Expert Teaching TOM to see around the corners requires Collins to work with the AI over the course of a few days. “Essentially what I do is I sit down with, in this case, a physician, and ask them, ‘What are thinking about when you make this decision?'” says Kuhnert. “The layperson might think that there are hundreds of variables in making a medical decision like this. With the expert’s tacit knowledge and experience, it is usually between seven and twelve variables. They decide based on these critical variables,” he says. "These experts have so much experience, they can cut away a lot of the noise around a decision and get right to the point and ask, ‘What am I looking at?’" Karl Kuhnert As TOM learns, it presents Collins with more and different scenarios for prescribing semaglutide. As she makes decisions, it remembers the variables present during her decision-making process. “Obviously, some variables are going to be more important than other variables. Certain combinations are going to be challenging,” says Collins. “Sometimes there are going to be some variables where I think, yes, this patient needs a GLP-1. Then there may be some variables where I think, no, this person really doesn’t need that. And which ones are going to win out? That’s really where TOM is valuable. It can say, okay, when in these difficult circumstances where there are conflicting variables, which one will ultimately be most important in making that decision?” The Process: Trusting AI After working with TOM for several hours, Collins will have reacted to enough scenarios for TOM to learn to make her decision. The Twin will need to demonstrate that it can replicate her decision-making with acceptable accuracy—high 90s to 100 percent. Once there, Collins’ Twin is ready to use. “I think it’s important to have concordance between what I would say in a situation and then what my digital twin would say in a situation because that’s our ultimate goal is to have an AI algorithm that can duplicate what my recommendation would be given these circumstances for a patient,” Collins says. “So, someone, whether that be an insurance company, or a patient themselves or another provider, would be able to consult TOM, and in essence, me, and say, in this scenario, would you prescribe a GLP-1 or not given this specific patient’s situation?” The patient’s current health and family history are critical when deciding whether or not to prescribe semaglutide. For example, according to Novo Nordisk, the makers of Ozempic, the drug should not be prescribed to patients with a history of problems with the pancreas or kidneys or with a family history of thyroid cancer. Those are just the start of a list of reasons why a patient may or may not be a good candidate for the medication. Kuhnert says, “What we’re learning is that there are so many primary care physicians right now that if you come in with a BMI over 25 and are prediabetic, you’re going to get (a prescription). But there’s much more data around this to suggest that there are people who are health marginalized, and they can’t do this. They should not have this (medication). It’s got to be distributed to people who can tolerate it and are safe.” Accessing the Digital Twin on TOM Collins’s digital twin could be available via something as easy to access as an iPhone app. “Part of my job is to provide the latest information to primary care physicians. Now, I can do this in a way that is very powerful for primary care physicians to go on their phones and put it in. It’s pretty remarkable, according to Colllins.” It is also transparent and importantly sourced information. Any physician using a digital twin created with TOM will know exactly whose expertise they are accessing, so anyone asking for a second opinion from Colllins will know they are using an expert physician from Emory University. In addition to patient safety, there are a number of ways TOM can be useful to the healthcare industry when prescribing medications like semaglutide. This includes interfacing with insurance companies and the prior approval process, often lengthy and handled by non-physician staff. “Why is a non-expert at an insurance company determining whether a patient needs a medication or not? Would it be better to have an expert?” says Collins. “I’m an expert in internal medicine and lifestyle medicine. So, I help people not only lose weight, but also help people change their behaviors to optimize their health. My take on GLP-1 medications is not that everyone needs them, it’s that they need to be utilized in a meaningful way, so patients will get benefit, given risks and benefits for these medications.” The Power of a Second Opinion Getting second, and sometimes third, opinions is a common practice among physicians and patients both. When a patient presents symptoms to their primary care physician, that physician may have studied the possible disease in school but isn’t necessarily an expert. In a community like Emory Healthcare, the experts are readily available, like Collins. She often serves as a second opinion for her colleagues and others around the country. “What we’re providing folks is more of a second opinion. Because we want this actually to work alongside someone, you can look at this opinion that this expert gave, and now, based on sourced information, you can choose. This person may be one of the best in the country, if not the world, in making this decision. But we’re not replacing people here. We’re not dislocating people with this technology. We need people. We need today’s and tomorrow’s experts as well,” according to Kuhnert. But also, you now have the ability to take an Emory physician’s diagnosing capabilities to physicians in rural areas and make use of this information, this knowledge, this decision, and how they make this decision. We have people here that could really help these small hospitals across the country. Caroline Collin MD Rural Americans have significant health disparities when compared to those living in urban centers. They are more likely to die from heart disease, cancer, injury, chronic respiratory disease, and stroke. Rural areas are finding primary care physicians in short supply, and patients in rural areas are 64 percent less likely to have access to medical specialists for needed referrals. Smaller communities might not have immediate access to experts like a rheumatologist, for example. In addition, patients in more rural areas might not have the means of transportation to get to a specialist, nor have the financial means to pay for specialized visits for a diagnosis. Collins posits that internal medicine generalists might suspect a diagnosis but want to confirm before prescribing a course of treatment. “If I have a patient for whom I am trying to answer a specific question, ‘Does this patient have lupus?’, for instance. I’m not going to be able to diagnose this person with lupus. I can suspect it, but I’m going to ask a rheumatologist. Let’s say I’m in a community where unfortunately, we don’t have a rheumatologist. The patient can’t see a rheumatologist. That’s a real scenario that’s happening in the United States right now. But now I can ask the digital twin acting as a rheumatologist, given these variables, ‘Does this patient have lupus?’ And the digital twin could give me a second opinion.” Sometimes, those experts are incredibly busy and might not have the physical availability for a full consult. In this case, someone could use TOM to create the digital twin of that expert. This allows them to give advice and second opinions to a wider range of fellow physicians. As Kuhnert says, TOM is not designed or intended to be a substitute for a physician. It should only work alongside one. Collins agreed, saying, “This doesn’t take the place of a provider in actual clinical decision-making. That’s where I think someone could use it inappropriately and could get patients into trouble. You still have to have a person there with clinical decision-making capacity to take on additional variables that TOM can’t yet do. And so that’s why it’s a second opinion.” “We’re not there yet in AI says Collins. We have to be really careful about having AI make actual medical decisions for people without someone there to say, ‘Wait a minute, does this make sense?’” AI Implications in the Classroom and Beyond Because organizations use TOM to create digital twins of their experts, the public cannot use the twins to shop for willing doctors. “We don’t want gaming the system,” says Collins. “We don’t want doctor shopping. What we want is a person there who can utilize AI in a meaningful way – not in a dangerous way. I think we’ll eventually get there where we can have AI making clinical decisions. But I don’t think I’d feel comfortable with that yet.” The implications of using decision-making digital twins in healthcare reach far beyond a second opinion for prescription drugs. Kuhnert sees it as an integral part of the future of medical school classrooms at Emory. In the past, teaching case studies have come from books, journals, and papers. Now, they could come alive in the classroom with AI simulation programs like TOM. "I think this would be great for teaching residents. Imagine that we could create a simulation and put this in a classroom, have (the students) do the simulation, and then have the physician come in and talk about how she makes her decisions." Karl Kuhnert “And then these residents could take this decision, and now it’s theirs. They can keep it with them. It would be awesome to have a library of critical health decisions made in Emory hospitals,” Kuhnert says. Collins agreed. “We do a lot of case teaching in the medical school. I teach both residents and medical students at Emory School of Medicine. This would be a really great tool to say, okay, given these set of circumstances, what decision would you make for this patient? Then, you could see what the expert’s decision would have been. That could be a great way to see if you are actually in lockstep with the decision-making process that you’re supposed to be learning.” Kuhnert sees decision-making twins moving beyond the healthcare system and into other arenas like the courtroom, public safety, and financial industries and has been working with other experts to digitize their knowledge in those fields. "The way to think about this is: say there is a subjective decision that gets made that has significant ramifications for that company and maybe for the community. What would it mean if I could digitize experts and make it available to other people who need an expert or an expert’s decision-making?" Karl Kuhnert “You think about how many people aren’t available. Maybe you have a physician who’s not available. You have executives who are not available. Often expertise resides in the minds of just a few people in an organization,” says Kuhnert. “Pursuing the use of technologies like TOM takes the concept of the digital human expert from simple task automation to subjective human decision-making support and will expand the idea of a digital expert into something beyond our current capabilities,” Kuhnert says. “I wanted to show that we could digitize very subjective decisions in such areas as ethical and clinical decision-making. In the near future, we will all learn from the wisdom codified in decision-making digital twins. Why not learn from the best? There is a lot of good work to do.” Karl Kuhnert is a Professor in the Practice of Organization & Management and Associate Professor of Psychiatry, School of Medicine and Senior Faculty Fellow of the Emory Ethics Center. If you're looking to connect with Karl to know more - simply click on his icon now to arrange a time to talk today.
The research team asked one group of participants to follow healthy eating accounts and another to follow interior design accounts After just two weeks, participants following healthy eating accounts ate more fruit and vegetables and less junk food Even minor tweaks to social media accounts could result in substantial diet improvements in young adults. Researchers from Aston University have found that people following healthy eating accounts on social media for as little as two weeks ate more fruit and vegetables and less junk food. Previous research has shown that positive social norms about fruit and vegetables increases individuals’ consumption. The research team sought to investigate whether positive representation of healthier food on social media would have the same effect. The research was led by Dr Lily Hawkins, whose PhD study it was, supervised by Dr Jason Thomas and Professor Claire Farrow in the School of Psychology. The researchers recruited 52 volunteers, all social media users, with a mean age of 22, and split them into two groups. Volunteers in the first group, known as the intervention group, were asked to follow healthy eating Instagram accounts in addition to their usual accounts. Volunteers in the second group, known as the control group, were asked to follow interior design accounts. The experiment lasted two weeks, and the volunteers recorded what they ate and drank during the time period. Overall, participants following the healthy eating accounts ate an extra 1.4 portions of fruit and vegetables per day and 0.8 fewer energy dense items, such as high-calorie snacks and sugar-sweetened drinks, per day. This is a substantial improvement compared to previous educational and social media-based interventions attempting to improve diets. Dr Thomas and the team believe affiliation is a key component of the change in eating behaviour. For example, the effect was more pronounced amongst participants who felt affiliated with other Instagram users. The 2018 NHS Health Survey for England study showed that only 28% of the UK population consumed the recommended five portions of fruit and vegetables per day. Low consumption of such food is linked to heart disease, cancer and stroke, so identifying ways to encourage higher consumption is vital. Exposing people to positive social norms, using posters in canteens encouraging vegetable consumption, or in bars to discourage dangerous levels of drinking, have been shown to work. Social media is so prevalent now that the researchers believe it could be an ideal way to spread positive social norms around high fruit and vegetable consumption, particularly amongst younger people. Dr Thomas said: “This is only a pilot intervention study at the moment, but it’s quite an exciting suite of findings, as it suggests that even some minor tweaks to our social media accounts might lead to substantial improvements in diet, at zero cost! Our future work will examine whether such interventions actually do change our perceptions of what others are consuming, and also, whether these interventions produce effects that are sustained over time.” Dr Hawkins, who is now at the University of Exeter, said: “Our previous research has demonstrated that social norms on social media may nudge food consumption, but this pilot demonstrates that this translates to the real world. Of course, we would like to now understand whether this can be replicated in a larger, community sample.” Digital Health DOI: 10.1177/20552076241241262
Improving Care for Black Patients With Heart Failure and Hypertension
ChristianaCare’s Center for Heart & Vascular Health has dramatically improved the clinical outcomes of Black patients living with heart failure and hypertension by using a digital hybrid platform that provides patients with a dedicated health coach to ensure their care plan is followed and treatment goals are achieved. Through this innovative approach, ChristianaCare achieved a significant improvement in the number of Black patients adhering to prescribed doses of guideline-directed medical therapy (GDMT) for heart failure. “At ChristianaCare, we are deeply committed to eliminating disparities and achieving health equity in the communities we serve,” said Kirk Garratt, M.D., medical director of the Center for Heart & Vascular Health. “We are proud that we have been able to significantly improve the health outcomes of our patients, especially addressing health disparities in the Black population for patients with heart failure and hypertension.” Approximately 32% of ChristianaCare’s heart failure patient population identify as Black, which is a higher percentage compared to the Black population nationally (12.4%). Historically, Black Americans have experienced racial disparities in heart failure treatment and experience worse patterns of adherence to guideline-directed medical therapy (GDMT) . Additionally, Black Americans have a 30% greater risk of death from heart disease than white Americans. Combining technology and human-powered guidance This novel approach to care is powered by Story Health, a leading health technology services company. Its digital platform and health coaches have been able to deliver superior outcomes for ChristianaCare’s patients regardless of race. Black patients in particular have made remarkable gains: 6 times improvement on target doses of beta blockers (76%). 7 times improvement on target doses ACE/ARB/ARNIs (54%). 2 times improvement on target doses of MRAs (57%). ChristianaCare was also able to achieve improvement in Black patients taking SGLT2 inhibitors, rising from a 32% baseline to 74%. Despite their vital role in treating heart failure, SGLT2 inhibitors are historically underprescribed and see lower adherence – largely due to affordability challenges, as costs can be $500 per month or more. Helping patients overcome cost barriers is critical, which is why the health coaches directly engage with patients to identify those who may need assistance and will work on their behalf to qualify for prescription assistance programs. “Along with their digital platform, the health coaches from Story Health understand the unique needs of our patients and have helped us create deeper, more accessible relationships with our patients to help improve their health and outcomes,” said Sourin Banerji, M.D., medical director of Advanced Heart Failure and Mechanical Circulatory at ChristianaCare. The health coaches serve as an extension of the clinician to identify and resolve challenges such as medication adherence, lab work coordination, transportation arrangement and even prescription assistance that cause disruptions in a patient’s care journey and lead to negative outcomes. Improved control of hypertension In addition to heart failure patients, ChristianaCare’s collaboration with Story Health supported patients with hypertension, delivering significant reductions in blood pressure for those enrolled regardless of race. Among Black patients specifically, there were significant decreases in average absolute systolic and diastolic blood pressure levels (17 mm Hg and 8 mm Hg, respectively) after 120 days, compared to 8 mm Hg and 5 mm Hg decreases for uncontrolled hypertensives in another digital program after 12 months. As a result of this initial success, ChristianaCare’s Center for Virtual Health is expanding the use of this care model beyond cardiology to support all patients in the population. Many of these patients struggle to manage high blood pressure, and the use of a continuous care program will be an important tool to help with medication management and addressing social barriers. “Health equity is an incredibly important initiative, and we see our mission as critical to helping specialty and primary care providers drive more equitable care,” said Story Health Co-founder and President Nita Sommers. “As an industry leader, ChristianaCare understands that every individual deserves compassionate care that is accessible, so we are honored to be working with its cardiology team and now the Center for Virtual Health to improve the health of patients.” ChristianaCare has been recognized numerous times for high-quality heart care. Among the many achievements are the American College of Cardiology HeartCARE National Distinction of Excellence Award for three consecutive years (2020-2023) and being named among Healthgrades top 100 hospitals for heart care in the U.S. for the past two years (2022-2023).
• Leading scientist wins €2.2 million ERC Advanced Grant • The five-year project will explore early dementia interventions through understanding how an aquaporin water channel regulates glymphatic clearance • ERC Advanced Grant funding is amongst the most prestigious and competitive of the EU funding schemes. A world leading scientist in the College of Health and Life Sciences at Aston University has been awarded a €2.2 million ERC Advanced Grant to understand how the movement of a protein known as aquaporin-4 in the brain can help slow cognitive decline. The FORTIFY project, which will run for five years, is led by Professor Roslyn Bill in the School of Biosciences. She will apply her discovery of the movement of aquaporin-4 to understand how the cleaning mechanism in the brain works during sleep. The research will focus on how aquaporin-4 controls the glymphatic system, which is the mechanism that allows us to clear waste products from our brains while we sleep. Her hypothesis is that the movement of aquaporin-4 in the brain changes the effectiveness of this cleansing mechanism - which lessens as people age. A greater understanding of this process could lead to an early intervention treatment that could slow the onset of dementia, such as Alzheimer’s and Parkinson’s Diseases. ERC Advanced Grant funding is amongst the most prestigious and competitive of the EU funding schemes, providing researchers with the opportunity to pursue ambitious, curiosity-driven projects that could lead to major scientific breakthroughs. Professor Bill said: “Every three seconds someone in the world develops dementia and there is no cure. I want to stop that from happening. By understanding the molecular mechanisms of brain waste clearance, we have an opportunity to develop medicines that can slow the onset of dementia, very much in the same way that statins are prescribed to control heart disease”. Roslyn Bill discovered that the water channel protein aquaporin-4 increases the permeability of brain cells to water after a brain or spinal cord injury. Around 60 million people a year suffer such injuries following falls or accidents. For example, after a skiing accident in the French Alps in 2013, Michael Schumacher suffered a severe head injury. He was placed in a medically induced coma and underwent several surgeries to treat his injuries. Until now doctors have only been able to manage the symptoms of brain injury (swelling on the brain) through interventions that may require surgery. Professor Bill and her team are due to start clinical trials in summer 2023, to test a method to stop the swelling from happening in its tracks, building on her discoveries. Roslyn’s new ERC-funded project, FORTIFY, will focus on how aquaporin-4 controls fluid flow in the healthy, uninjured brain. In this round of Advanced Grants, the European Research Council (ERC) is awarding €544 million to 218 outstanding research leaders across Europe, as part of the Horizon Europe programme. The grants will support cutting edge research in a wide range of fields, from medicine and physics to social sciences and humanities. The grant is awarded to established, leading researchers with a proven track-record of significant research achievements over the past decade. The funding will enable the researchers to explore their most innovative and ambitious ideas. Mariya Gabriel, European Commissioner for Innovation, Research, Culture, Education and Youth, said: “ERC grants are a top recognition and a significant commitment from our best researchers. The €544 million funding puts our 218 research leaders, together with their teams of postdoctoral fellows, PhD students and research staff, in pole position to push back the boundaries of our knowledge, break new ground and build foundations for future growth and prosperity in Europe” Maria Leptin, ERC President, added: "These new ERC Advanced Grantees are a testament to the outstanding quality of research carried out across Europe. I am especially pleased to see such a high number of female researchers in this competition and that they are increasingly successful in securing funding. “We look forward to seeing the results of the new projects in the years to come, with many likely to lead to breakthroughs and new advances.”
What Are Cardiac Arrest and Heart Attack?
Fast Action Saves Lives. When Buffalo Bills safety Damar Hamlin collapsed during an NFL game against the Cincinnati Bengals, it brought urgency to knowing signs of a cardiac arrest and what to do in case of a medical emergency involving the heart. It’s a common misunderstanding that cardiac arrest and heart attack are the same. They are different, but both are very serious heart problems and require fast action to save lives. "I think the very best bit of news for Mr. Hamlin is that the emergency medical technicians got to him very quickly." Heart attack and other conditions, including a rare type of trauma called commotio cordis, may disrupt the heart’s rhythm and lead to cardiac arrest. Commotio cordis can occur from a severe blow to the chest as in a sports injury. What is cardiac arrest? Cardiac arrest happens when the heart malfunctions and stops beating unexpectedly. Cardiac arrest is triggered by an electrical malfunction in the heart that causes an irregular heartbeat known as arrhythmia. The heart’s cardiac conduction system – or “electrical” system – is a specialized network of heart cells that keeps it beating regularly and effectively. With the heart’s pumping action disrupted, it cannot pump blood to the brain, lungs or other organs. Cardiac arrest often happens to people who didn’t know they had a heart problem. Symptoms of cardiac arrest Seconds after a cardiac arrest, a person becomes unresponsive, is not breathing or is only gasping. Death can occur within minutes if the victim does not receive treatment. Causes of cardiac arrest Cardiac arrest can run in families. People who have a family history of sudden cardiac death have a higher risk for sudden cardiac death. Other health problems can increase the chance of a deadly heart rhythm including: Heart disease (coronary artery disease). A heart attack. Heart failure. Hypertrophic cardiomyopathy. This makes the heart thicker and larger than normal. Blow to the chest that disrupts the heart rhythm as in commotio cordis. Speak with your health care provider to learn if you have a health problem that raises your risk of cardiac arrest; treatment of that problem may help lower your risk. Medicine often can control the heart rhythm. Helping someone having a cardiac arrest Cardiac arrest can be reversible in some victims if treated within a few minutes. Health professionals, family or friends and even strangers may be able to help a person right away who has cardiac arrest. First, call 911 and start CPR right away. Click here for CPR basics, including videos. Then, if an Automated External Defibrillator (AED) is available, use it as soon as possible. AEDs are often available in airports, malls, and other public places. Click here for how to use an AED. If two people are available to help, one should begin CPR immediately while the other calls 911 and finds an AED. In the ambulance and hospital, the person will receive emergency care. This care keeps the heart and lungs working to prevent damage to the body due to lack of oxygen. Doctors will try to find the cause of the cardiac arrest to prevent another one. AEDs are portable, life-saving devices designed to treat people experiencing sudden cardiac arrest, a medical condition in which the heart stops beating suddenly and unexpectedly. What is a heart attack? A heart attack occurs when blood flow to the heart is blocked. A heart attack is a circulation problem with the heart. A heart attack occurs when part of the heart muscle does not get enough blood and oxygen. This part of the heart starts to die. Symptoms of a heart attack The most common symptom of a heart attack is chest pain or pressure. Some people describe it as discomfort, squeezing, or heaviness in the chest. Other symptoms may be immediate and may include intense discomfort in the chest or other areas of the upper body, shortness of breath, cold sweats, nausea or vomiting. Some people feel symptoms in other parts of their upper body such as: Pain or discomfort in your back, jaw, throat, upper belly or arm. Sweat, feeling sick to your stomach or vomiting. Trouble breathing. Feeling lightheaded or suddenly weak. A racing or fluttering heartbeat. More often, though, heart attack symptoms start slowly and persist for hours, days or weeks before a heart attack. Unlike with cardiac arrest, the heart usually does not stop beating during a heart attack. The longer the person goes without treatment, the greater the damage. Heart attack symptoms in women can be different than men (shortness of breath, nausea/vomiting, and back or jaw pain). Address heart attack symptoms immediately Even if you’re not sure it’s a heart attack, call 911 if you have symptoms. Every minute matters. Emergency medical services staff can begin treatment when they arrive — up to an hour sooner than if someone gets to the hospital by car. These professionals also are trained to revive someone whose heart has stopped. Patients with chest pain who arrive by ambulance usually receive faster treatment at the hospital, too. Click here for CPR training classes held by the American Heart Association in your area.