Some gains aren’t worth it

My son attends an excellent high school, recently ranked #1 in Nebraska by a national publication. He has great academic opportunities, and he takes advantage of these. He is out doing some volunteer work for his National Honor Society application as I write these words. He also loves sports.

His first love is baseball (homerun shown), and he plays all summer. Since 8th grade he has played football as well (it’s the state religion of Nebraska). He has played offense and defense on the freshman and sophomore teams, and he got to suit up with the varsity as a long-snapper for one game last year.

He will not be playing this fall.

Oh, he has gone to weight training almost every weekday at 8am all summer long. He even attended football camp. He finally decided that the payoff was not worth the effort required.

Or the pressure to gain weight.

No one offered him steroids. No one offered any nutritional advice. No one suggested supplements, other than other kids on the team. But coaches did mention that he should try to put on 30 lbs or so if he wanted to play a position besides snapper.

He is currently between 90th-95th percentiles for height, and just above the 90th percentile for weight with rippling muscles I never imagined anyone with my genes could possess. Adding 30 lbs to his frame would increase his body mass index from a healthy 27.2 to an obese 31.8.

He came to this decision on his own. He did not want to get fat because that would mess up his baseball game, not to mention setting him up for health problems later in life (his father has type 2 diabetes). He plans on academic scholarships and achievements, not sports, for his future.

I wonder how many boys on his team could make this decision? I wonder how many of them would pack on pounds in hopes of football glory and a chance to go to college with the sport? I wonder what happens to them, metabolically, when their playing days end?

My daughter quit her dance major because of the pressure to lose weight when she had no body fat to shed. Now my son is giving up a sport  because he refuses to become obese.

I am proud of both of them. But I am worried about all our children.

The Truth About Scientific Research

I remember attending my 10th high school reunion. I was in my fellowship in pediatric nephrology, and my former classmates were amazed that I was “a real MD.” When I confided that I really liked doing research, they asked what discoveries I had made.

Science doesn’t work like that.

Yes, I know, people win Nobel prizes for “discovering” something or other. It may not be exactly what they set out to find, and it is very likely that their “discovery” is different from their original hypothesis. Novel data also get dissed. The first descriptions of many phenomena are relegated to “low-impact-factor” journals because reviewers refuse to believe something that is truly novel.

Science proceeds nonlinearly and incrementally. Only in retrospect can the path from A to B be seen. Several experiments may suggest a direction, but the overriding truth comes from a body of work. At other times an incidental part of the study proves to be more important than what was originally the goal.

For example, I start out interested in condition X which is known to be associated with factor A. I believe that factor A produces factor B which promotes condition X. I do an experiment that shows A produces B; however, my follow-up shows that B produces D in the presence of C. Someone else has shown that D causes condition Y. We now show that blocking C can prevent condition Y. Not what I set out to prove, but perhaps an important “discovery” if Y is a major health issue.

Advances depend on one thing: money. Generous sources of funding allow us to perform experiments and learn more about how life works. At the present time only 20% of studies are getting money from NIH. Peer review is a pretty good system, but you never know where a critical observation will come from. Reviewers also tend to favor more conservative work that is expected to go as planned rather than stuff that may provide novel break-through results. The NIH has tried to get around this issue, but hasn’t solved the problem yet.

Science is like a river of facts. As it flows and eddies form, seemingly unrelated streams from different sources may come together, making a whole that is more than the sum of its parts. And you never know which creek upstream will provide the critical drop.

Photos courtesy of PhotoXpress.com

A True Story

Last week I wrote about My Sister’s Keeper, a novel and movie to be released this Friday, June 26. Today I also tell a story about the need for a kidney transplant, but today’s account is true.

The story I tell is not one of my patients; that would violate a number of rules. No, this tale belongs to someone I know through friends and relatives. If she wishes to claim this saga as her own, she may do so by commenting. I will not “out” her.

The girl entered this world 18 years ago into a loving family. She had hypoplastic left heart syndrome, a condition in which the part of the heart that pumps blood to the body is malformed and cannot do its job. The best therapy for this condition, at that time, was cardiac transplantation. On her first roll of the dice she got lucky. An appropriate infant donor was found, and her life continued.

She grew up like most children. Although she required medicines to keep her body from rejecting her heart, she walked and talked and acted like a normal kid. Unfortunately anti-rejection drugs can damage other organs. After a number of years her kidneys were failing. Once again the gods smiled on her, and her mother was able to give her a transplant.

With high school completed, she dreams of going to college this fall and living independent of her parents, and she has been accepted. Finances are tight, but the dream is still in sight. Except…

Except her tranplanted kidney, like most, is not going to last forever. When the damage became apparent, a work-up for a new kidney began. Unfortunately, she has developed antibodies to a number of histocompatibility loci: the things that the body recognizes as self or not-self. The more antibodies the body has formed, the better the match has to be. This girl now requires a virtually perfect match. No one in her extended family fits.

She has already defied the odds. She now faces dialysis and a long wait for a new kidney. She has relatives willing to donate; they hope that someone who is a match will be willing to make a swap (see page 1 article in May Issue here).

She still holds onto her dream of college away from home. It can be done on dialysis, and I suspect she will figure out a way to make it happen. Compromises may be necessary. But she still hopes for that magic kidney.

No Hollywood ending here. Not even a reality TV ending. Just an 18 year old girl with a dream for a new kidney and a normal life.

Every transplant center has similar stories to tell. Please consider being an organ donor after you die, or even before.

Click here for more information on being an organ donor.

Click here or on the logo for more information on the Alliance for Paired Donation.

Genius at Work

My son, Tim, plays many roles. The photo shows his debut at third base last Friday. He did field the ground ball and made the out at first.

I'm not going to tell a baseball story tonight. Unlikely as it seems, I'm going to share a story about AP Statistics. Tim is a sophomore, but has always done well at math. The final assignment this year in his stats class was to design a study and perform it. A fair amount of work went into this, and they worked in pairs. Tim and a buddy decided to test whether colors of gummi bears are equally distributed in packages.

Tim is a gummi connoisseur. Gummi bears, worms, fish, and fruit are all fair game, although the gummi bear has the best surface to interior ratio, in his opinion. He even managed to eat these with braces!

First, they had to assure a random sample. Thanks to the internet, they were able to find out that all gummi manufacturers fill their bags randomly. They did some sample size analysis, purchased a sufficient sample size, and then got together during study hall to count their bears. After covering a table in the library with a newspaper, they poured all 4 pounds into the middle in a giant mountain of gummi. As they were dividing it into same-colored piles, the librarian inquired about their project. I believe the exact quote was "No food in the library!"

They finally convinced her that this was a legitimate homework project, and she consented to let them take the table into the hallway outside the library door. They counted up the bears and have now turned in a paper documenting that red gummi bears outnumber the others, while yellow ones are less common. I'm hoping to get a copy of the paper to post because someone out there needs to know this factoid!

OK, so you've finished your research project. Each boy now has 2 pounds of gummi bears... which each proceeded to eat! In ONE DAY. Tim has decided he doesn't need to see a gummi bear anytime soon.

This story was the funniest thing I heard for several days, so I thought I would share. Remember, these are the rewards of having a kid in an AP class!

Gummi Bears Photo: copyright PhotoXpress.com