Effects of a caloric restriction weight loss diet on tryptophan metabolism and inflammatory biomarkers in overweight adults.

PURPOSE: Recent data suggest that chronic low-grade inflammation, a characteristic of obesity, is associated with altered tryptophan (Trp) and tyrosine (Tyr) metabolism and plays a role in neuropsychiatric symptoms. The present study assessed the effect of an extreme short-term diet on Trp breakdown and inflammatory biomarkers in overweight adults. METHODS: Thirty-eight overweight participants (16 women, 22 men; average body mass index: 29 kg/m², mean age 52.8 years) were randomized into two diet groups: a very low kcal diet group (VLCD; Ø 600 kcal/day, n = 21) and a low kcal diet group (LCD; Ø 1,200 kcal/day, n = 17). Assays included the measurement of Trp, kynurenine (Kyn), and their ratio, neopterin, phenylalanine (Phe), Tyr, as biologic markers; leptin, plasma insulin, glucose, and homeostatic model assessment-insulin resistance; and interleukin 6, tumor necrosis factor alpha, and C-reactive protein, as biochemical and inflammatory markers at baseline and after 2 weeks of treatment. RESULTS: Weight loss diet lowered leptin levels in both groups by 46%, although not reaching significance. Trp and Kyn decreased significantly by 21 and 16% for VLCD and by 15 and 17% for the LCD group, respectively. A significant reduction in Phe was only seen after VLCD. Inflammatory biomarkers, neopterin, and Tyr were not significantly altered during the study period. Leptin was significantly correlated with Trp breakdown before and after the intervention (P < 0.02). CONCLUSIONS: Since disturbed metabolism of Trp affects biosynthesis of serotonin and might be associated with increased susceptibility for mood disturbances and carbohydrate craving, strategies to supplement Trp while dieting could be highly useful in treating uncontrolled weight gain or in preventing neuropsychiatric symptoms.

Health and sports law collide: do professional athletes have an unfettered choice to accept risk of harm?

Is there a positive duty at law to prevent an athlete with a serious medical disability from performance, despite the player accepting the risk? Is high risk of serious injury or death in the athletic context equivalent to euthanasia? Euthanized death is a predictable consequence of deliberate action. Accepting high risk in the athletic context is distinguishable. Athletes are often more likely able to make voluntary decisions without the burdens of incurable pain and clouding medications. Should policy reasons, nonetheless, preclude athletes from accepting high or uncertain risks of serious injury or death? What standard of medical certainty or legal certainty is appropriate regarding the "right to risk"? The higher the risk of serious injury or death and the less the medical uncertainty the more tort law might trump contract principles. In contrast, medically certain outcomes are easier to knowingly and voluntarily assume by way of contract. Waivers are contracts and present a conflict between a person's rights to have freedom to contract and negligence. Contracts shift the risk. An athlete can be disqualified to avoid a significant risk of injury that cannot be eliminated through reasonable medical accommodations. The problem is that physicians tend to be conservative and without any input from informed athletes, many otherwise disabled players would be refused participation, albeit with a high risk. If an athlete is able to seek medical treatment that reduces the risk and does so, an athlete's will to return should not be ignored. The team must substantiate the restriction by justifying a relatively certain and substantial risk. An athlete may agree to accept high risk of serious injury or death through a contractual waiver to insulate others from liability in negligence. Independent legal advice and advice from medical experts ensure that such waivers are legally enforceable. As medical law has broad application, dealing with improving the rights, rules and policies of health care as it relates to the use of advanced medical technologies in potentially vulnerable persons and consequently the right to accept risk, is as important both evaluative and meritorious exercise for all health and legal systems throughout the world.

Rating healthy organizational performance.

Across the spectrum of philanthropy, donors are asking what evidence exists that an organization is actually creating positive, meaningful and sustainable change. Just as patient outcomes were adopted to demonstrate the efficacy of treatment, so too should organizational outcomes be adopted by health care facilities and the development organizations that support them to demonstrate the tangible and lasting benefits to the communities they serve.

Science convicting the innocent.

This paper focuses on the dangers of scientific evidence in criminal cases. The general reliability of scientific evidence is reviewed. Second, cases are evaluated thus tracing the development of the rules set out for the admissibility of scientific expert evidence. Third, cases are analyzed and the existing rules are criticized; this analysis grounds several proposed changes set forth as a protection for an accused person from possible dangers accompanied with scientific evidence. And finally, this paper proposes that the trial judge should exercise more active and comprehensive discretion to exclude potentially dangerous scientific evidence. Instead of assessing threshold reliability questions, the trial judge should determine the actual reliability of scientific evidence under the ad-hoc circumstances of the particular case before him. The trial judge should then determine if the scientific evidence meets the new tests, as proposed in this paper, for scientific admissibility, depending on whether the defense or the prosecution relies on science and how close science is to the ultimate issue of guilt or innocence. In judge-rule trails, judges must rule on the scientifically more accurate theory, but not on the more convincing expert.

Informed consent: information or knowledge?

A fiduciary relationship should be nurtured between patient and physician. This requires effective communication throughout all aspects of care - especially pertaining to treatment decisions. In the context of illness as experienced by the patient a unique set of circumstances is presented. However, communication in an illness context is fraught with problems. The patient is vulnerable and the situation may be overwhelming. Voluminous amounts of information are available to patients from a host of health care providers, family members, support groups, advocacy centers, books, journals, and the internet. Often conflicting and confusion, frequently complex, this information may be of greater burden than benefit. Some information is of high validity and reliability while other information is of dubious reliability. The emotional freight of bad news may further inhibit understanding. An overload of information may pose an obstacle in decision-making. To facilitate the transformation of information into knowledge, the health care provider must act on some occasions as a filter, on other occasions as a conduit, and on still other occasions simply as a reservoir. The evolution of patient rights to receive or refuse treatment, the right to know or not to know calls for a change in processing of overwhelming information in our modem era. In this paper we will discuss the difference between information and knowledge. How can health care providers ensure they have given their patients all necessary and sufficient information to make an autonomous decision? How can they facilitate the transformation of information into knowledge? The effect of knowledge to consent allows a more focused, relevant and modern approach to choice in health care.