TIME Developmental Disorders

Autism Symptoms Disappeared With Behavioral Therapy In Babies

Baby on fur rug
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Parents using ground-breaking new techniques with infants essentially cured their babies of developmental delays

For the first time, researchers report that treating early signs of autism in infants as young as 6 months can essentially help them to avoid developmental delays typical of the disorder. And the intervention doesn’t involve pills or invasive surgery but an intensive behavioral therapy provided by the babies’ parents, according to the Journal of Autism and Developmental Disorders.

Kristin Hinson was one of those parents. She knew what autism looked like. With two of her three children showing developmental delays, she was on the lookout for similar signals when her son Noah was born. And at 6 months, they came. Noah began avoiding eye contact with her and other family members, his muscle tone was low, and he started lagging in the early infant milestones like rolling over and responding to sounds and people. “He was doing everything, but everything was a little sloppy,” says Hinson.

Because she had two children affected by autism, Noah was enrolled in a study of infant siblings of autistic children at the University of California Davis. Noah’s symptoms appeared relatively early — at that age, doctors can’t diagnose the developmental disorder, but they know the hallmarks that are strongly associated with it. Noah’s sibling history also meant there was a good chance he would eventually show delays in language and social skills as well.

MORE: Brain Imaging Could Detect Autism Risk in Infants as Young as 6 Months

He was fortunate enough, however, to be one of seven children to begin an intensive, parent-based program for treating autism in infants as young as 6 months. The goal of the program is to slow or avoid the symptoms of autism that often mean affected children need special education or other formal care as they get older.

Hinson attended 12 sessions for an hour once a week at the Institute, and continued to apply what she had learned there during each of her interactions with Noah at home for six weeks while following up with their counselor. The techniques she and the other parents learned were based on the Early Start Denver Model, which was developed by Sally Rogers, a professor of psychiatry at UC Davis, and Dr. Geraldine Dawson at Duke University.

The program involved intensive and intentional play by trained therapists at children’s homes. Once a week, the therapists went to the families’ homes and purposefully engaged with the toddlers, who were between three years and five years old. Even when they were rebuffed, the therapists would persist, finding objects that appealed to the children and inserting themselves into the child’s play with that object so they were forced to have more social engagement. Eventually, the children responded, and even showed brain changes that suggested their brain patterns were normalizing to look more like those of children unaffected by autism.

With the latest group, Rogers moved the program earlier, to babies between 6 months and 15 months old, well before autism is usually diagnosed. Because the babies were so young, Rogers wanted to test whether parents could be taught the same techniques that therapists used, so the strategy could be applied more consistently and frequently than a few times a week, and during daily interactions with the infants—while they were fed, diapered, bathed and more.

MORE: Study: Siblings of Autistic Kids Show Similar Brain Activity

The results were astounding. Six of the seven infants in the study essentially caught up in their learning and language skills by age two or three. They no longer showed developmental delays in social communication or language, and behaved just as a control group of children unaffected by the disorder.

“At 18 months, Noah just blossomed,” says Hinson. “He started talking, and really socializing. Before, he wasn’t really engaging with others, and all of a sudden it felt like a light flipped on.”

Noah is attending a mainstream preschool, and Hinson doesn’t anticipate he will need any special education or tutoring to keep up with his classmates once he enters kindergarten,

Doctors, especially psychiatrists, don’t like to use the word “cure.” But, says Rogers of the small, promising group of infants like Noah who were part of the study, “We are curing their developmental delays.”

MORE: Behavior Therapy Normalizes Brains of Autistic Children

She’s careful not to suggest that the behavioral therapy can cure children of autism, since the only a handful of babies were involved, and they haven’t been studied long-term yet. But the findings do support the idea that intervening early, and with intensive therapy, can make a difference in the trajectory of the disorder.

The results also suggest that the progression of autism isn’t inevitable, and that its symptoms aren’t entirely biologically or genetically preordained. “If a baby doesn’t smile at you, doesn’t make eye contact, doesn’t respond pleasurably to your many interactions or doesn’t ever call for your attention, you don’t know if you’re on the right track,” she says of the typical early signs of autism. “If the message you get from them is that they aren’t interested, then you’re not going to continue.” Over, time, she says, that limits the number of social learning opportunities that the babies have, and they may spiral deeper and deeper into their own world. “Over time, the parents and children accommodate the child’s interest in objects and lack of interest in people.”

The behavioral training that she provides parents counters this cycle, and forces parents to find ways to engage their child, even if it means using the inanimate objects that appeal to them. If an infant is captivated by a stuffed animal, for example, then parents are trained to enter their baby’s field of vision, and play with the animal by using it to tickle the child, or tickle himself. The parent might even hide the stuffed toy under her shirt, and encourage the baby to find it. “The parent takes over so the child is now interested in the parent because there is a game going on with the toy and the parent,” says Rogers. “The key is to create a social game so the object is now serving the people instead of taking over the child’s attention.”

That shift takes effort, however, and it isn’t easy. “The first month I felt really frustrated,” admits Hinson. “There was a lot of pressure on me.” She says that it took most of the 12 week program before she felt completely comfortable with the new way of interacting with Noah, with inserting herself into his “circle” of attention at every opportunity, and with waiting for him to respond to her forays at communication.

But, she says, it was well worth the effort, and it comes easily. “Every new skill, like teaching him nursery rhymes and songs, or trying to get him to share something, and show me something, didn’t come natural to me at first. But when he started giving me some reciprocation, like smiling and babbling, it was like I was getting rewarded for the hard work.”

The skills are “completely doable,” says Hinson, and far less intrusive than having therapists visit the home once a week, which she did for her two older children who were developmentally delayed. “It’s brilliant if you can get the hands-on training. Because as parents, we are in their circle all the time, every day of their lives, and what better way to help them than to do it every day at every opportunity.”

While she’ll never know if the program was actually responsible for helping Noah to avoid developmental delays, Hinson is sure of one thing. “If they could have had something like this for my other children, I think they would be completely different children today.”

 

TIME Cancer

Lung Cancer May Be Detected With a Thermometer

Detecting lung cancer may be as simple of taking the temperature of your exhaled breath, say researchers

In the continuing effort to find less invasive ways of detecting lung cancer, scientists from Italy announced that your breath’s temperature could be a giveaway of tumors within.

In a report presented at the European Respiratory Society International Congress, Giovanna Carpagnano, from the University of Foggia, said that among 82 people who showed potential signs of lung cancer on X-rays, those who had confirmed lung cancer had higher breath temperatures than those whose readings weren’t as high.

While many factors could contribute to breath temperature, the team also found that the readings were higher the more the participants had smoked, and among those with later-stage cancer.

The findings need to repeated and confirmed, but efforts to find easier ways of diagnosing lung cancer that don’t require biopsies of lung tissue, are gaining ground. Scientists are also working on ways to identify specific chemicals that made by tumors and the odors they emit in the breath. “If we are able to refine a test to diagnose lung cancer by measuring breath temperature, we will improve the diagnostic process by providing patients with a stress-free and simple test that is also cheaper and less intensive for clinicians,” Carpagnano wrote in a statement describing the research.

TIME medicine

Kate Middleton Has Morning Sickness—Again

It’s déjà vu for Duchess of Cambridge. Another pregnancy, another battle with morning sickness.

Along with the good news that Kate Middleton is pregnant and expecting her second child, who would be fourth in line to the throne, Middleton also revealed that she is suffering from hyperemesis gravidarum, a severe form of morning sickness that landed her in the hospital during her first pregnancy.

Having the condition during a previous pregnancy increases the chances that it will recur, which may explain Middleton’s circumstances. Consistent nausea and vomiting can lead to dehydration and deficiencies in some important nutrients, say experts, so expectant moms who can’t keep food down are treated with IV fluids. It’s generally not dangerous to the developing fetus, unless the mom-to-be doesn’t gain enough weight during pregnancy, which can lead to lower-birth weight babies. (George, her first child, was born at a healthy 8 pounds, 6 ounces.)

This time, the Duke and Duchess’ office says, she is being treated at home, which for her is Kensington Palace.

For those who might have forgotten, hyperemesis gravidarum can be caused by hormonal changes occurring during the first three months of pregnancy—specifically the steep rise in human chorionic gonadotropin (HCG), which is released by the placenta as it readies to nourish the fetus.

Presence of hydatidform moles, or a growth inside the uterus, can also trigger the severe nausea and vomiting.

There’s something else that often triggers the morning sickness: twins. No word just yet from the royals on whether George will be joined by more than one sibling.

TIME Healthcare

Joan Rivers’ Death Raises Questions About Outpatient Care Centers

Joan Rivers Signs And Discusses Her New Book "Diary Of A Mad Diva"
Comedian Joan Rivers poses before signing copies of her new book "Diary Of A Mad Diva" at Barnes & Noble bookstore at The Grove on July 10, 2014 in Los Angeles, California. Amanda Edwards—WireImage

The comedien apparently went into cardiac arrest while undergoing a procedure at an outpatient center, and had to be transported to a hospital for emergency care

The New York Department of Health is still investigating the death of Joan Rivers, who died Thursday when she did not recover from cardiac arrest. Rivers, 81, was at Yorkville Endoscopy, an outpatient surgical center, for an elective procedure when she ceased breathing and her heart suddenly stopped. An autopsy proved inconclusive, the New York chief medical examiner’s office said Friday.

Rivers’ death is raising questions about how outpatient or ambulatory centers are accredited, and what regulations are in place to ensure patient safety. Each state health department oversees such facilities; some are part of hospitals and therefore regulated by the same organizations that oversee hospitals, while others are independently owned and operated by physicians.

Just under half of states, including New York, require that the latter centers receive accreditation from any of four organizations that set criteria for patient care and safety. The New York Department of Health lists threeAccreditation Association for Ambulatory Health Care, American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF), and the Joint Commission.

As one of the organizations that accredits centers for which Medicare reimburses procedures, the AAAASF has a 162 page checklist of items, from requiring that a circulating nurse is in both the operating room and the recovery rooms, to board certification of surgeons performing the procedures and the presence of crash carts for resuscitating patients should complications occur. Centers also need to have an agreement with a nearby hospital to respond to any emergencies. Because of these criteria, says Dr. Geoffrey Keyes, president of AAAASF, death rates at ambulatory surgery centers that are accredited are similar to those at hospitals.

But if states do not require accreditation or licensure, then centers have to voluntarily apply for the status, which can cost $10,000 over three years and require regular inspections for compliance.

While the majority of ambulatory surgery centers are accredited by one of the four agencies perform the service in the U.S., the bulk of the smaller practices run by one or two physicians who perform surgical procedures at their offices are not. “One of the first questions a consumer should ask a surgeon is what environment do they intend to do the procedure, and whether that environment is accredited, whether it’s a hospital or outpatient center,” says Michael Kulczycki, executive director of the Ambulatory Care Accreditation Program of the Joint Commission.

If the facility is accredited, while it’s no guarantee that complications won’t occur, it’s a reassurance that a high level of patient safety and surgical standards are being met. “My personal belief is that with proactive risk and safety measures in place, and appropriate plans to mitigate emergencies, care in the ambulatory care environment would be as safe as care in an inpatient environment,” says Dr. Daniel Ross, field director for ambulatory programs at the Joint Commission.

TIME medicine

What May Have Caused an American Pilot to Crash

Socata Plane
A Socata TBM-900 (700N) at Glasgow airport in Scotland on March 14, 2014. Iain Marshall

An unresponsive pilot whose plane crashed off Jamaica may have suffered from hypoxia

A New York real estate executive was piloting his his small plane from Rochester to Florida on Friday when he stopped communicating with air traffic controllers before eventually crashing near Jamaica.

Larry Glazer, who frequently flew that route, was traveling with his wife. FAA officials said the private plane had reached an altitude of 25,000 feet, prompting some officials to speculate he may have suffered from something known as hypoxia, in which parts of the brain are deprived of adequate oxygen.

It’s far too early to know for sure. But at that altitude, oxygen is so thin that brain cells can only survive for several minutes before they start dying off. Without enough oxygen, people become inattentive, show poor judgment and eventually stop breathing. With extended exposure at high altitudes, the brain shuts off and slips into a coma. Military pilots dispatched to track the aircraft after it failed to respond to air traffic control signals reported seeing the pilot slumped over.

The FAA has warned non-commercial pilots of the dangers of high altitude changes and hypoxia—in its first phases, the pilot won’t necessarily be aware that he’s experiencing oxygen deprivation. On the FAA site’s training section, a member of the agency’s education team urges more physiology training of pilots so they are aware and prepared for the dangers of hypoxia.

According to an official 1991 FAA report, Civilian Training in High-Altitude Flight Physiology, “Some National Transportation Safety Board staff members have expressed a concern that high-altitude flight physiology training for civilian flight personnel should receive greater emphasis than it currently does.” The report goes on to say, “When pilots combine their private flying skills with their business transportation needs and use their aircraft to meet those needs, it is inevitable that in order to meet a schedule, arrive at a destination, or get home after a meeting, the urge to complete a mission will lead the pilot into a physiologically-unsafe altitude or into conditions for which there has been insufficient training or experience.”

TIME Research

Journal Retracts Paper that Questioned CDC Autism Study

A paper that claimed government scientists covered up data showing a connection between vaccines and autism has been pulled by its publisher

Earlier in August, the journal Translational Neurodegeneration, an open access, peer-reviewed journal, published a re-analysis of a 2004 paper published in Pediatrics that looked at MMR vaccines and autism. The re-analysis of the data, by biochemical engineer Brian Hooker of Simpson University, claimed to find a higher rate of vaccination against MMR among a subset — African-American boys — of the original study population who developed autism than among those who did not, a finding that Hooker claims was suppressed by the authors of the original paper from the Centers of Disease Control. One of the co-authors of the 2004 paper, William Thompson, released a statement admitting to omitting the data after a secretly recorded conversation he had with Hooker was released on YouTube. (Thompson was not available for comment.)

MORE: Whistleblower Claims CDC Covered Up Data Showing Vaccine-Autism Link

Now, however, the editors of Translational Neurodegeneration have retracted Hooker’s paper, noting on its site that “This article has been removed from the public domain because of serious concerns about the validity of its conclusions. The journal and publisher believe that its continued availability may not be in the public interest. Definitive editorial action will be pending further investigation.”

TIME medicine

Whistleblower Claims CDC Covered Up Data Showing Vaccine-Autism Link

The claim, however, may just be more unsubstantiated fuel from the anti-vaccination movement

If you haven’t noticed, there’s a war going on between those who believe in the health benefits of vaccines – that they can prevent deadly infectious diseases such as measles and polio – and those that believe that the immunizations do more harm than good. Now one of the authors of a 2004 government study that found similar vaccination rates among children with and without autism says the study omitted some important data.

The vaccine war is being fought on social media, in social circles and increasingly in doctor’s offices, as physicians are faced with doubts and questions from parents who find themselves being recruited onto the side of skepticism. Skepticism is healthy, and the sign of curious minds, but not when it flies in the face of evidence. Especially gold standard, rigorous scientific evidence that has been accumulating for decades and shows that vaccines are not linked with an increased risk of the developmental disorder.

William Thompson, a senior scientist at the Centers for Disease Control (CDC) and one of the authors of a 2004 study published in the journal Pediatrics, spoke with Brain Hooker, who serves on the board of Focus Autism (which was founded to “put an end to the needless harm of children by vaccination and other environmental factors”), about the data that was not included in the final report. The study looked at both healthy children and those with autism, to see if there were any differences in their rates of being vaccinated against measles, mumps and rubella (MMR), and found none. That suggested that childhood immunizations likely were not contributing to an increased risk of autism. Hooker and Thompson, however, discussed a subset of the 624 children with autism and 1824 without the condition who were studied and Thompson admitted that among African-American boys, the incidence of autism was higher among those who were vaccinated than among those who weren’t. But that information was not part of the paper. Thompson claims he was not aware that the discussion was being recorded, and his statements appeared in a video released on YouTube on August 22 entitled “CDC Whistleblower Revealed.”

Did the CDC cover up the data, as Hooker claims? A couple of things to keep in mind, both about the people behind the video and about how epidemiological studies like the one published in Pediatrics work (and explained in more detail in this article from Science-Based Medicine). For starters, the video was narrated by Andrew Wakefield, the British researcher responsible for seeding the questions about vaccines and autism in the first place. In 2010, the General Medical Council in the UK revoked his license to practice medicine and a year later, the journal that published his paper concluded that his findings were fraudulent.

Next, any time scientists take the original population of participants in a study, however large, and drill down to analyze trends in a subgroup – in this case the African-American boys – the power of the associations they find dwindles. That’s because the numbers get smaller, and in order to be statistically relevant – something known as statistical significance to statisticians – certain threshold numbers and confidence intervals for the connection have to be reached. In the 2004 study, the scientists looked at a smaller set of 355 children with autism and 1020 without for whom they had Georgia state birth certificates, which included additional information that might be relevant for any associations, such as birth weight, gestational age, and mother’s age, race and education. “This information was not available for the children without birth certificates; hence the CDC study did not present data by race on black, white or other race children form the whole study sample. It presented the results on black and white/other race children from the group with birth certificates,” the CDC notes in a statement responding to the video. Thompson claims that the findings were statistically significant, but results from smaller numbers of subjects still don’t hold as much weight as correlations found in the larger group.

In addition, it’s important to note that the study simply correlated age at vaccination and reports of autism, which says nothing about the direction of the connection. For example, the authors of the 2004 study note that “Case children, especially those 3 to 5 years of age, were more likely than control children to have been vaccinated before 36 months of age.” The association between vaccination and symptoms, however, was more likely due to the fact that the children had to be immunized in order to register in preschool, and doesn’t necessarily indicate that the shots contributed to the autism.

In a statement issued through his attorneys, Thompson says “Reasonable scientists can and do differ in their interpretation of information.” He calls for transparency in the data collecting and reporting process, but says that the way that the 2004 study was presented does not negate the importance of vaccination. “I want to be absolutely clear that I believe vaccines have saved and continue to save countless lives. I would never suggest that any parent avoid vaccinating children of any race. Vaccines prevent serious diseases, and the risks associated with their administration are vastly outweighed by their individual and societal benefits.”

TIME Brain

Erasing Bad Memories May Soon Be Possible

Blank photo
Getty Images (1); Illustration by Mia Tramz for TIME

Using state of the art laser and gas techniques, scientists working with mice make stunning breakthroughs in turning bad memories into better ones

Memories are a complex combination of objective information—the color of a car, the size of a building—and less tangible emotional feelings, like fear, anxiety, joy, or satisfaction. But to scientists, memories are nothing more than a series of chemical and physical changes, the firing of a nerve here, which sends electrochemical impulses to another nerve there, which together encode everything that we associate with a memory.

But exactly what do those changes look like? And is it possible to override them? In a milestone paper published in the journal Nature, scientists may have provided some answers, explaining how emotional baggage gets attached to memories, and how that can be manipulated to quite literally turn bad memories good. In separate work appearing in the journal PLOS ONE, researchers say that a commonly used anesthetic gas, xenon, if administered at exactly the right moment, can also strip the painful and negative feelings associated with a traumatic memory, essentially neutralizing it.

The findings from both groups come from mouse studies, but the two teams are confident that the results will further efforts to understand and find new ways to treat depression and post traumatic stress disorder in people.

In the Nature study, Susumu Tonegawa and his team showed for the first time exactly where in the brain both positive and negative memories are created, and how these emotional layers can be switched around. They exploited a cutting-edge technique they developed called optogenetics to track an emotional memory as it’s made and also manipulated in the brains of mice. They studied both positive experiences—male mice were allowed to spend about an hour with female mice—and negative experiences—the mice were given mild foot shocks.

MORE: 5 Secrets to Improve Learning and Memory

First, the researchers administered a protein, called channelrhodopsin, into mice nerve cells that were activated during and immediately after those experiences (the positive and the negative). The protein reacts to a specific blue wavelength of laser light—and the scientists discovered that when that light was administered to the the part of the mouse’s nerve cells that fired up after those good or bad experiences, the emotion associated with the memory was relived as though it were happening all over again, even absent the stimulus that created it in the first place.

“Optogenetics for the first time allowed us to pin down the cells in the brain that literally carry the information for a specific memory,” says Tonegawa.

The real revelation came when the scientists tested how malleable the connection between the shock and the memory was. They allowed the shocked mice to spend time with females while their brains were hit with the blue light—which triggered their fear of the shock even though they didn’t get one. After 12 minutes of the laser exposure, the mice relaxed. But it wasn’t that they had replaced their fear with more pleasant feelings. Images of their brains showed that new circuits, presumably the ones associated with more positive feelings of being with females, had sprouted between the emotional regions of the brain and the memory center. Likewise, the mice that had had the pleasurable experience with their female counterparts were given the shock while exposed to the blue light, and now showed more fear and anxiety. The original emotional associations were not eliminated and replaced. Instead, says Tonegawa, the positive and negative circuits compete with each other, and whichever is dominant becomes the prevailing emotion linked to a memory.

MORE: This Is the Brain Circuit That Makes You Shy

That could explain how some psychotherapy currently works. To help depressed patients address their feelings, some therapists will revisit negative or emotionally painful experiences. Because memories are not recalled and returned in exactly the same way like a recording, any new information attached to that memory—such as more neutral or positive perspectives about the episode—can help to diffuse its negative impact. Tonegawa’s work in animals suggests that it’s possible to make that psychotherapy technique even more effective if therapists can help patients to focus on more positive feelings while reconsolidating painful memories.

That’s what another group, at McLean Hospital, is hoping to do with a much more simplistic strategy. Edward Meloni, an assistant professor of psychiatry at Harvard Medical School and Marc Kaufman, director of the McLean Hospital Translational Imaging Laboratory, found that the gas xenon, which is used in anesthesia (primarily in Europe), can neutralize the fear associated with a traumatic memory. Exposing mice that had experienced foot shocks to the gas dramatically reduced their fear behaviors – such as freezing up and avoiding areas associated with the painful shock – for up to two weeks. That’s because xenon preferentially targets certain receptors, called NMDA, on brain nerves that are concentrated in learning and memory regions. So when a traumatic memory is activated, those neurons involved in recalling that memory are prime targets for xenon, which blocks the cells from making their usual connections to the emotional hub in the brain known as the amygdala. “My speculation is that xenon lessens the impact of the emotional component, the real emotional pain associated with a traumatic experience,” says Meloni.

MORE: Memories Can Now Be Created — And Erased — in a Lab

It’s not clear yet whether the gas will have similar effects on long-standing traumatic memories such as those involved in PTSD, but Kaufman and Meloni plan to set up a human trial as soon as possible. Ideally, says Meloni, if xenon proves to be effective and safe for reshaping memories, patients who experience debilitating nightmares would be able to give themselves a squirt of xenon just as they would use an asthma inhaler. Since the gas dissipates quickly, so far there doesn’t seem to be a reason to worry about other potentially harmful effects on the brain.

And what about situations that don’t quite reach the level of PTSD, but are traumatic nonetheless, such as the death of a loved one or a bad breakup? “In general I think those painful experiences are probably not going to be impacted by xenon because there really isn’t a specific memory that is reactivated, like a flashbulb moment of trauma,” he says. “It’s more a global heartbreak.”

Because xenon isn’t specific to blocking the negative connections to the brain’s emotional nexus, Kaufman says it’s possible the gas could also be helpful in reducing the highs and the reward sensation associated with addiction. More studies will need to show that xenon could play a role in those situations as well, but both he and Meloni are optimistic. “We’ve got a good start in animals, and as we work through the ladder in getting it to people, I’m hopeful,” says Meloni.

TIME Heart Disease

Eating and Exercise Needs to Be Part of Heart-Health Counseling, Say Docs

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Comstock—Getty Images

A government panel of experts found that behavioral counseling to help people at risk of heart disease to adopt healthier habits can lower their risk of having heart events. But it’s not easy

We know how to lower our risk of heart disease, yet it remains the leading killer of Americans year after year. That’s because the most powerful ways to fend off heart attacks and strokes are also the hardest. Changing our diet and exercise habits involves changing our lifestyles, and doctors have yet to come up with the perfect prescription for that.

But a group of government-convened experts says that one strategy shows promise. They studied the latest trials investigating what works and what doesn’t in getting people to eat healthier and move more, and found that behavioral counseling, either by physicians or nurses or specially trained counselors, can lower risk of heart problems in people who are overweight or obese.

“Intensive behavioral counseling does seem to move the needle,” says Dr. Michael LeFevre, chair of the U. S. Preventive Services Task Force and vice chair of family and community medicine at the University of Missouri Columbia. “We can take people at elevated risk – for starters, people who are overweight or obese and have at least one other risk factor for heart disease — and saw modifications in their risk factors that we think are great enough to have an impact on their health down the road.”

The task force reviewed 74 trials of intensive behavioral counseling – which included education about heart health, nutrition and physical activity, as well as individualized programs in which the participants were provided feedback and problem-solving strategies – and heart outcomes. The counseling was not associated with any harms or serious adverse events, but the sessions did lead to lower cholesterol levels and blood pressure over two years and a decrease rate of diabetes over four years. About a quarter of people were exercising at a moderate to intense level (150 minutes of exercise per week) after several years compared to 10% who were at the start of the studies.

MORE: Prostate-Cancer Screening: Men Should Forgo PSA Testing, Panel Advises

That’s good news, says LeFevre, and prompted the task force to recommend behavioral counseling in a statement published in the Annals of Internal Medicine to help people reduce their risk of heart disease.

The advice is an endorsement of the more formal counseling that more primary care doctors are relying on help their at-risk heart patients. It’s also a definitive statement against the current standard in which doctors merely urge their patients to lose weight or exercise more. “What we didn’t find evidence to support is what most of us do in our practice,” says LeFevre, who is a practicing primary care doctor. “And that is, we just say to John Doe sitting across from us who is overweight, has high blood pressure and smokes, to lose weight. John says, ‘I’m working on that.’ And I say ‘Let me know if I can help – just cut back to eating 1500 calories a day and walk every day.’ We don’t find any evidence that helps.”

What does work, he says, is a program that links both diet and exercise interventions, and that typically helps participants over several sessions occurring over several months, and involves many hours of interaction with a counselor. In those sessions, setting goals and addressing barriers to reaching those goals is an important part of the behavioral counseling – that’s what helps the patients to actually change their behavior rather than simply think about it.

MORE: U.S. Panel Recommends Delaying Regular Mammograms Until Age 50

But as a primary care doctor, LeFevre admits that the counseling isn’t exactly practical or widespread – yet. “One of the major barriers for implementation is that the resources aren’t out there. Many physicians simply don’t have the personnel, programs or location to which to refer people to make this happen.”

That’s the purpose of the USPSTF recommendation—by providing the scientific evidence supporting the benefits and effectiveness of behavioral counseling, LeFevre and the task force members hope that more doctors and hospitals will provide such programs to help their patients—and potentially contribute to lowering heart attacks and heart disease deaths. “We know the risk factors for heart disease pretty well, and we know that behavior change can alter your risk. So the question is, what can the health care community do to support that behavior change? We combed through the literature and looked at all the studies, and this is what seems to work,” he says.

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