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Category Archives: Medical School

Older People Need Geriatricians. Where Will They Come From? – The New York Times

That describes Dorothy Lakin, 93, whose recent medical history includes heart failure, macular degeneration, falls, colon cancer and heart valve surgeries, and a stroke.

Shes had a zillion trips to the E.R., one after another, said her daughter Mary Ellen Lakin, 70, who lives in Newton, Mass. I thought, lets see if theres a way to make her life easier.

Mary Ellen Lakin found her way to Dr. Laura Nelson Frain, a geriatrician at Brigham and Womens Hospital in Boston, who has gently steered mother and daughter through the past year. She reduced the number of medications Dorothy Lakin took and the specialists she saw, stayed in touch with Mary Ellen and sent a geriatric nurse-practitioner to make house calls.

Its less of Lets order this med, lets order that procedure, more of a holistic approach, Mary Ellen Lakin said. Her mother recently entered hospice care.

Nevertheless, given the numbers, were not going to address this growing older population through some miraculous influx of specialized geriatricians, Mr. Petriceks said.

Leaders in geriatrics agree, and while they continue working to bolster their numbers, theyre also adopting other strategies. Dr. Mary Tinetti, chief of geriatrics at the Yale School of Medicine, has called for geriatricians to serve as a small, elite work force who help train whole institutions in the specifics of care for older adults.

The most important thing geriatricians can do is make sure all their other colleagues understand these patients needs, she said, including nurse-practitioners, physician assistants, therapists and pharmacists.

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Two founding faculty members retire from Oakland University William Beaumont School of Medicine – News at OU

Two faculty members integral to the establishment and sustained success of Oakland University William Beaumont School of Medicine are retiring from the school, effective Jan. 3.

The retirees are Barbara Joyce, Ph.D., associate professor, Department of Foundational Medical Studies, and Rachel Yoskowitz, BS (Nursing), MPH, assistant professor, Department of Foundational Medical Studies and global health director.

Both have been with OUWB since the schools beginning.

They will long be remembered for helping set the tone for OUWBs mission, vision, and values, said Robert Noiva, Ph.D., associate dean of Graduate Studies & Community Integration and associate professor in the Department of Foundational Medical Studies

The values that they established with infrastructure, with the curriculum, and with the extracurricular activities, is going to continue, said Noiva. And thats where personal satisfaction comes in knowing that you really had an impact, and these are two people who really did have an impact in establishing the school.

Leveraging experience at OUWB

Joyce joined Oakland University William Beaumont School of Medicine in 2010 as an associate professor and director of curriculum evaluation. She also designed, developed and implemented the Behavioral Science course, and served as its director since 2012. She was integral in setting the infrastructure for curriculum mapping, course and faculty evaluations, and in competency-based education.

Before joining OUWB, Joyce was director of instructional design at Henry Ford Health System and a clinical associate professor in the Department of Family Medicine at Wayne State University.

At Henry Ford Health System, she designed, implemented, evaluated curricula, assessment tools, program improvement processes, and provided faculty development for 45 residency and fellowship training programs accredited by the Accreditation Council for Graduate Medical Education (ACGME). In addition, she designed educational curricula, assessment tools, and program improvement processes for the Henry Ford Health System Center for Simulation Education and Research. Before that, Joyce was senior project manager at the ACGME, where she worked on the Outcome Project and provided faculty development on the competencies.

Additional past experiences include associate director of behavioral science at Genesys Regional Medical Center, where she led training for family medicine residents and health psychology post-doctoral fellows, and she was also director of behavioral science at Sinai Hospital in Detroit.

Joyce has spoken nationally and internationally on topics relevant to medical education and faculty development. She trained as a clinical psychologist.

Joyce said she was recruited to join OUWB and said the idea "of building a new medical school was appealing because I thought it would be an opportunity to leverage all of the experiences Ive had in my career.

The Behavioral Science course, in conjunction with the Art & Practice of Medicine course, developed a comprehensive two-year communication curriculum that covers topics such as interviewing, sharing bad news, treatment adherence, intimate partner violence and includes the use of standardized patients throughout.

There is no other school in the country that has this kind of robust curriculum, she said. If I were to identify what Im most proud of here, that would be it.

Though looking forward to giving herself the gift of time, Joyce said she will look back fondly at her experiences at OUWB.

Teaching, for me, has always been about something bigger than just doing a lecture, she said. Because at the end of all of the training in medical school, theres a patient a patient often very vulnerable and in need of care.

With that in mind, Joyce said she has always maintained focus on developing innovative, engaging, and outstanding curriculum for medical students, so that they can develop skills to deliver compassionate care.

What great heights

Yoskowitz joined OUWB in 2011 as an assistant professor in the Department of Biomedical Sciences (now the Department of Foundational Medical Studies). She would also become coordinator of OUWBs community and global health programs.

Before joining OUWB, Yoskowitz served as the founding director of Project Chessed, a nationally recognized access-to-care network for low-income uninsured adults in metro Detroit.

Yoskowitzs career also includes having served as director of education for the American Lung Association of Minnesota and director of adolescent health for the Delaware Division of Public Health. In that role, she oversaw the expansion of school-based health centers to every public high school in Delaware.

She engaged with communities both professionally and as a volunteer through the International Council of Nurses Exchange Visitor Program, refugee resettlement and working in urban community clinics, receiving recognition for her community service role in advocacy and outreach to refugees.

Her additional experience includes being a clinical nurse in perioperative nursing, a head nurse in medical-surgical nursing, and an instructor of Fundamentals of Nursing and Medical-Surgical Nursing at the Johns Hopkins Hospital School of Nursing.

It was in her role at Project Chessed that she took part in a focus group on what would become OUWB and was led by Linda Gillum, Ph.D., former associate dean for academic and faculty affairs at OUWB.

Yoskowitz said Gillum mentioned to her the possibility of working at OUWB.

I thought she was being gracious, Yoskowitz said. But then I thought maybe she meant it, so I called her.

Yoskowitz said she made the call because the opportunity sounded really challenging and exciting.

And I thought that it would get me back into a stimulating educational environment, she said.

At OUWB, Yoskowitz taught global health and along with OUWB Founding Dean Robert Folberg, developed the schools Compass department that advises medical students on their community engagement.

In fact, Yoskowitz smiles as she recalls coming up with the name Compass one weekend early in her OUWB tenure.

I thought about a compass, which points us in the right direction, she said. Its also the first part of the word compassionate, so it reminds us of our mission to be compassionate, caring physicians.

In addition to Compass, she also developed, implemented and coordinated departments monthly Hot Topics in Medicine Lunch n Learn Seminar Series.

Further, Yoskowitz was charged with the responsibility of teaching and implementing OUWBs global clinical opportunities that now include partnerships with universities and health systems in Korea, the Philippines, and Israel (in the picture at right, Yoskowitz is in Jerusalem with OUWB Class of 2019 alumni Eva Ma and Brian Lee).

In reflecting on what she takes the most pride in during her time at OUWB, Yoskowitz said its the education she helped provide students.

I am most proud that I have in some small measure influenced future doctors' world view and enabled them to look at global health issues and refugees in a different lens, she said. As faculty we are, after all, educators and influencers. When all is said and done, I hope that I have been true to that role.

Yoskowitz is looking forward to traveling with her husband, and spending more time with her grandchildren.

Like Joyce, however, she said she will miss OUWB and a wonderful group of colleagues.

Their passion and their commitment to medical education, and how they extend themselves to help students succeed, is very impressive, she said.

Yoskowitz said she finds it somewhat hard to believe eight years have already passed since she started at OUWB, but believes the school has been set up for decades of success.

I can only imagine what great heights, and the plateaus that OUWB will reach, in the next 100 years, she said.

For more information, contact Andrew Dietderich, marketing writer, OUWB,

Follow OUWB on Facebook, Twitter, and Instagram.

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Our top 10 news stories of 2019 – AAMCNews

Medical school in 3 years. The pros and cons of making the USMLE pass/fail. New research into the doctor shortage and, in particular, the shortage of surgeons. These and other top AAMCNews stories of 2019 offer a glimpse into some of the most pressing issues facing students, residents, and faculty at our nations medical schools and teaching hospitals.

In case you missed them, here are our 10 most-read stories of the year:

1. Why women leave medicine

Research shows that almost 40% of women physicians go part-time or leave medicine altogether within six years of completing their residencies. Heres whats behind the early exodus and what pioneering institutions are doing to entice more women to stay.

2. New findings confirm predictions on physician shortage

In April, the AAMC released its annual report on physician supply and demand in the United States. The report shows that the U.S. could see a shortage of up to 122,000 physicians by 2032, impacting patient care across the nation.

3. What happens when a teaching hospital closes?

When Hahnemann University Hospital in Philadelphia announced in June that it was filing for bankruptcy, it set in motion a chain of events that affected everyone from students and residents to program directors, faculty, and patients. Heres how the closure affected not only the 550trainees displaced, but the academic medicine community at large.

4. Should the USMLE be pass/fail?

USMLE Step 1 scores get far more weight than they deserve in the residency selection process, experts say, and thats harming students. Now for the first time, key stakeholders have come together to reform USMLE and the entire selection process.

5. Med school in 3 years: Is this the future of medical education?

Accelerated programs cut student debt and produce grads faster to address physician shortages. But some worry they might sacrifice valuable learning and professional development.

6. DACA students risk everything to become doctors

Nearly 200 undocumented students and residents are training in U.S. medical schools and teaching hospitals. AAMCNews talked to 10 DACA medical students and residents about their journeys to medical school, the challenges they faced as the undocumented children of immigrants, and the passion that drives them to pursue a career in medicine despite tremendous obstacles.

7. So youve matched: Now what? 9 things all residents should know

Value your team. Ask for help. Remember that it gets better. Medical school deans and teaching hospital CEOs offer their best advice for new residents.

8. SWAT doctors

They rush into active shooter scenes and other unimaginably dangerous situations. What it's like to train and serve as a physician on a special operations team.

9. How well does the MCAT exam predict success in medical school?

Researchers spent years studying thousands of students to assess the new MCAT exam. Here are some of their key and surprising discoveries.

10. Desperately seeking surgeons

By 2032, the United States will lack as many as 23,000 surgeons. That will have a dramatic impact given a growing, aging population with increasingly complex health needs.

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The Future Is Now: A Diverse and Inclusive Faculty – Columbia University Irving Medical Center

Illustration: Davide Bonazzi.

This spring during her maternity leave, Stephanie Lovinsky-Desir, MD, updated progress reports to the NIH on her research into asthma among kids living in urban areas, reviewed grant applications and abstracts for the American Thoracic Society, flew to Chicago to present an abstract at an American Society for Clinical Investigation meeting, and drove to Baltimore to give an oral presentation of her research at a Pediatric Academic Society meeting. When an opportunity presents itself, its really hard to say no, says the pediatric pulmonologist and mother of three. Junior faculty members are expected to have exponential growth in this early part of our careersbut it overlaps with when were raising young families.

And yet, says Dr. Lovinsky-Desir, compared with the shorter leaves she had after her older two children were born, the 13-week parental leave policy instituted across Columbia University Irving Medical Center (CUIMC) in January 2018 was a significant benefit. While it was still hard to come back to work, especially leaving a new baby with a cold, it was really nice to have that extra month of bonding time with her, she says.

In 2017, for the first time, more women than men enrolled in VP&S. This past year, women were the majority of both medical school applicants and enrolled students nationwide. Racial and ethnic diversity likewise continues to increase among medical students, with nearly 50% of medical students in the United States identifying as non-white. And while great strides have been made in diversifying the ranks of academic medical facultyboth at Columbia and across the countrywomen and people of color remain under-represented at the highest levels of academic ranks, administration, and leadership. To address the issue, VP&S administrators have dedicated recruitment, hiring, and programmatic efforts to expanding the pipeline of women and underrepresented minority faculty to serve the educational, clinical, and research missions of VP&S and to take on leadership roles.

Diversity at all levels of medicine, including students, trainees, faculty educators, researchers, and practitioners, is critically important to educate students to understand medical problems that quickly and easily cross global borders; to deliver culturally sensitive health care to a population that is multicultural, multinational, and multilingual; and to bring new and different research perspectives to the research agenda, says Anne Taylor, MD, vice dean for academic affairs. American medical education, practice, and research can only remain the best by using the full intellectual capital derived from recruiting the most committed, accomplished, and talented workforce from every segment of our population.

The effort at VP&S got a substantial boost in April 2018 when Lee Goldman, MD, dean of the faculties of health sciences and medicine and chief executive of CUIMC, convened two faculty committeesone dedicated to the particular career challenges faced by women and the other to those of underrepresented minoritiesto develop recommendations that would strengthen ongoing efforts to promote opportunities for career success at VP&S for all faculty. Dr. Goldman reviewed the recommendations submitted jointly by the two committees and accepted them in full this year. While the recommendations were developed by advisory committees, their implementation will position VP&S to be the best place for academic medical faculty to flourish, says Dr. Taylor, whose office provided administrative support for the committees.

Convening the committees was part of the medical schools ongoing efforts over the past decade to be sure that career development needs of all faculty are met. These efforts also recognize that women and underrepresented minority faculty face additional unique challenges to career development that require more professional development efforts. Earlier efforts have resulted in measurable progress. Among VP&S faculty 47% are women, compared with the national average of 39%. Even at the highest ranks, 29% of VP&S full professors are women compared with 25% nationally, and 35% of the medical schools tenure-track faculty are women, leading Columbias peer group of medical schools. Racially and ethnically diverse people make up 20% of the faculty at VP&S, with 11% (compared with 8% nationally) from groups traditionally underrepresented in the professoriate.

In recent years, the academic tracks were restructured to create a transparent, objective basis for academic advancement and to minimize arbitrary and potentially exclusionary promotion practices. Parameters of equity, such as numbers of women and diverse faculty in leadership positions and on key committees that review candidates for promotion and honors, are closely monitored to assure a balanced representation of the faculty, and salary equity between men and women is regularly measured. To ensure continued efforts, VP&S committed $50 million to programs to recruit and support women and diverse faculty.

Chief among the recommendations Dr. Goldman endorsed to promote the success and retention of new recruits and current faculty is creation of an Office for Women and Diverse Faculty. All of our programs are driven by faculty interest and faculty demand, says Dr. Taylor. Hired in late 2007, about 18 months after Dr. Goldman became dean, Dr. Taylor now holds the John Lindenbaum Professorship of Medicine and also serves as senior vice president for faculty affairs and career development for CUIMC. From that vantage point, she sees implementation of the committees recommendations as the latest advance in the work with which she was charged when she joined Columbia.

When I came to the medical school, there were no professional development programs for faculty, says Dr. Taylor. VP&S hires some of the most gifted faculty members in the country, so it is our responsibility to support their career success and satisfaction. Her office now oversees orientation programs; leadership and management training, including sessions for all women and diverse faculty cohorts; workshops focused on career development and academic advancement for educators, researchers, and clinicians; and workshops focused on teaching skills, negotiation skills, and management of research teams. Working with women faculty, Dr. Taylor helped to develop the Virginia Kneeland Frantz Society for Women Faculty. Implementation of the advisory committees recommendations will allow for expanded professional development programs but importantly will offer the opportunity to create further changes in the overall culture and climate around diversity and equity.

When Hilda Hutcherson, MD, arrived at Columbia in 1981, she was the first African American woman resident in obstetrics & gynecology. On this campus, there were few African American residents at the time in any department, or even faculty members, she recalls. When I started as an assistant professor in 85, there were no programs to encourage minorities or women to pursue academic medicine. Now a professor of obstetrics & gynecology and senior associate dean for diversity and multicultural affairs, Dr. Hutcherson served on the Committee for Faculty Diversity and Inclusionand she is pleased that the committees work has been so enthusiastically endorsed by the dean. When the list of recommendations was put together, I dont think anyone was thinking wed get 100%, she says. Im so happy that Dr. Goldman took all of the recommendations.

In the absence of formal programs to support her own career development, says Dr. Hutcherson, informal relationships were key to her success. During her early years on the faculty, Gerald E. Thomson, MD, now the Samuel Lambert and Robert Sonneborn Professor Emeritus of Medicine, took note of her passion for encouraging students from diverse backgrounds and urged her to consider formal opportunities to mentor others. It wasnt something I was pursuing at first, says Dr. Hutcherson. Dr. Thomson thought I would be really good and a natural fit and encouraged me to applythats how I ended up in this position. She not only transformed what was once a small office dedicated to recruitment of underrepresented minority medical students into an office with a broader set of programs that support all medical center students, she founded and leads the Kenneth A. Forde Diversity Alliance, which is dedicated to recruiting, retaining, and recognizing a diverse community among students, residents, faculty, and alumni.

Informal associations like that with Dr. Hutcherson and Dr. Thomsonwhereby higher-ranking professionals in the field champion the career trajectories of junior facultyplay a critical role in sustaining diversification of leadership of academic medicine, says plastic surgeon Christine Rohde, MD. These relationships, which differ significantly from the peer-to-peer mentorship and networking many professionals already enjoy, are important but should be supplemented by formal mentoring and sponsorship opportunities available to all, says Dr. Rohde. The Office of Faculty Professional Development, Diversity & Inclusion led by Clara Lapiner, MPH, promotes mentorship and sponsorship for faculty within departments but also has made sponsorship of faculty for outside career development part of its mission.

A sponsorship opportunity from the Office of Faculty Professional Development, Diversity & Inclusion provided funding support from the Virginia Kneeland Frantz Society for Dr. Rohde to attend an AAMC mid-career development training program for women faculty. Since the program began in 2016, 29 women and 20 underrepresented faculty have received funding support to attend AAMC career development seminars. Faculty who have received such support share what they have learned with others. At the end of that course I wrote a list of the things I wanted to try to do in my work life and some were very, very specifictalking to a particular individual about things I wanted to achieve in the futureand others were more general about how I could grow, contribute, increase visibility, says Dr. Rohde. Sponsors have really put me forward for things I wouldnt have thought of myself.

As vice chair of faculty development and diversity for the Department of Surgery and chief of microvascular services at CUIMC, Dr. Rohde now has opportunities to mentor and sponsor colleagues earlier in their careers, with a particular eye on cultivating diversity among those being recommended for leadership. There are scholarships geared toward women, underrepresented minorities, and Ill find people in my department who are eligible, encourage them to go for it, talk to people who will nominate them, she says. And as a Chinese American mother of three, she chooses to take on highvisibility rolesas co-chair of the Women Physicians of NewYork-Presbyterian, as a leader in her professional societies, as a member of the deans advisory committee for women faculty, and now as she applies for a full professorship, a pursuit relatively rare among female surgical faculty. Im very conscious of what I do and what that means for other people who may want to follow my career path in academic plastic surgery, she says. The kids are watchingif we say diversity is important, but the field is not, I think they pick up on that.

Pathologist Richard Francis says he has seen significant shifts in the institutional culture at VP&S since he was a student in the MD-PhD program and since he was hired as faculty in 2011. I feel like it is sincere, the idea of making this a better place for people to work, for patients to be seen, for people to receive their education, says Dr. Francis, who directs the Special Hematology and Coagulation Laboratory and served with Dr. Hutcherson on the deans advisory committee for faculty diversity and inclusion. I dont get the impression that its just lip service, but real follow-through where you can see differences.

He sees particular promise in the deans endorsement of the faculty recommendation that all departments offer training in detecting and fighting implicit bias the unconscious attitudes and stereotypes that can affect behavior. It feeds back into interviewing students, residents, faculty, he says. People need to understand how they view people, how that affects who they recommend, and how they approach trainees and job offers.

In his own career, he has found connection through programs like a Harold Amos Medical Faculty Development Program award from the Robert Wood Johnson Foundation, which expanded his access to mentors. As you get further along, having people to mentor you who are more like you, look like you, have gone through things that youve experienced matters more.

To provide that kind of access among the residents he meets in clinical rotations, Dr. Francis keeps lines of communication open, often helping trainees process their own encounters with implicit bias. Much of that work boils down to acknowledging and validating painful experiences. Sometimes he shares insights from his own journey or offers advice. Its not that someones trying to disrespect you, says Dr. Francis. Theyre updating their schemasometimes it works and sometimes it doesnt and theres friction in that process.

Diverse perspectives advance the kind of problem-solving central to academic medicine, Dr. Francis notes. Acknowledging the friction that can sometimes emerge and working through difficult processes are critical steps for achieving the potential a diverse workforce promises. You have to do something to foster that environment, make sure everyone has an equal voice, that they know that what they have is something of value, he says. Everyone needs to know that their perspective will be heard.

As chair of the Department of Emergency Medicine since January 2018, Angela Mills, MD, has hired 34 new faculty. Among them are 21 women and nine people of color. Diverse teams are smarter, and teams that are both gender and culturally diverse are more likely to introduce innovations, says Dr. Mills. Both as problem solvers and as educators, she says, leaders in academic medicine must innovate. Yet implicit bias often interferes with the recruitment and retention of a diverse team. To reduce that risk, Dr. Mills has standardized as much of the process as possible by requiring that nominating committees define hiring criteria in advance and search committees develop a panel of questions each candidate must answer. What we ask candidates and how we evaluate them is really important when were talking about diversity, she says. Without clearly defined criteria, people tend to redefine characteristics of what theyre seeking to promote male candidates, less diverse candidates.

As a member of the deans advisory committee for women faculty, Dr. Mills brought to the table her personal experience as a first-generation college student, woman, and mother of two rising through the ranks of emergency medicine, as well as her scholarship on the gender gap in her field. In February, the Society for Academic Emergency Medicine published her analysisco-authored with colleagues at Harvardon gender differences in faculty rank among academic emergency physicians in the United States. Later that month, she gave a VP&S grand rounds lecture on the gender gap in academic medicine. Nationally, Dr. Mills notes, more than 50% of medical students are women. Among all residents, 46% are women; in emergency medicine, however, only 37% of residents are women. And the number keeps falling off, she says. The question is how do we promote emergency medicine as a specialty that supports women, promotes women, and allows women to successfully transition into academic medicine if they choose?

She has found that the new 13-week parental leave policy helps recruitment. I use that as a selling tool, and Ive had just as many men as women take parental leave, she says. Its a great benefit to all parents. She also is optimistic about the potential of #SHEmergency, a professional development group that fosters community and develops methods for awareness of gender bias among female-identified residents and emergency medicine faculty. The groups article, #Shemergency Presents: Recruitment & Retention of Female Residents, appeared this summer in AAMCs journal, Academic Medicine. We developed specific events where residents and faculty partner on strategies and plans to combat disparitieseverything from mentorship to speaking invitations, awards and recognition, salaries.

Like Dr. Francis and Dr. Rohde, Dr. Lovinsky-Desir credits an early career development award for providing the professional connections and coaching she needed to take a tactical approach to her own career advancement. In my regular circles on the academic campus, often Im the only woman of color, she says. Its important to see people in leadership who look like you, who have gone through similar experiences. If theyve made it, I too can make it.

Among members of the deans advisory committee for faculty diversity and inclusion, the power of solidarity and connection made the idea of an Office for Women and Diverse Faculty particularly attractive, says Dr. Lovinsky-Desir. As the odd person out, sometimes your voice gets lost. Its a little harder to speak up, she notes. If theres a space where we can unite, uplift one another, I think it will empower us as we go back into our teams.

This article originally appeared in the 2019 VP&S Annual Report.

Already, says Dr. Lovinsky-Desir, she sees other changes emerging from the recommendations advanced by the deans advisory committeesa powerful, self-reinforcing effect both on campus culture and the advancement of women and minorities across VP&S. She was recently invited to serve on a search committee. Not only was she able to lend her perspective on the search itself, Dr. Lovinsky-Desir was fascinated by the insights she gleaned about what search committees prioritize when assessing candidates for senior leadership positions. We often dont get that as junior faculty, women, minorities, she says. I learned so much about what features are valued in a person in senior administrative leadership, and that perspective will enhance my growth here as a junior faculty member.

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Do you really need to walk 10,000 steps a day? Experts say there’s a better goal – USA TODAY

Walking 10,000 steps a day isa good baseline to help you stay fit, but it isn't the one-size-fits-all goal you might think.

Fitness trackers such as Fitbit usethe number as a default goal, but fitness experts suggest tailoring a step goal to an individual. Researchers traced the origins of the 10,000-step practiceto a marketing gimmick from the 1960s and suggested some people don't greatly benefit from walking so much.

Harley Pasternak, a celebrity personal trainerwho works with Fitbit,sets the goal of at least 10,000 steps for his clients. He explained in an email to USA TODAYthat the step requirement, if it includes 30 minutesat a moderate intensity,satisfies guidelines for exercise set by the Centers for Disease Control and Prevention 150 minutes of moderate-intensity exercise a week.

I recommend to strive for 14,000 if youre trying to lose weight, he said.

Pasternak cautioned that the suggestionvaries based on lifestyle, and for some people, setting a lower goal would be ideal.

A Harvard study of nearly 17,000 women ages 66 to 78 found that those who walked 7,500 steps or more had the lowest mortality rate.

Even women who walked 4,400 steps had a lower mortality rate than those who were the least active and walked only about 2,000 steps. There were few, if any, additional benefits for the women who walked more than 7,500 steps.

I-Min Lee, a professor of medicine at Harvard Medical School and the lead researcher in thestudy, told USA TODAY the 10,000-steps-a-day recommendation was developed in the 1960s by early pedometer makers.

"It got started as a marketing tool for a Japanese company," Leesaid, referring to a Japanese pedometer released in 1965called the "10,000 steps meter." She said there haven't been any scientific studies backing up that number. Asked why it became standard, she explained simply,"It's an easy number to remember."

Lee suggestedwalking 2,000 more steps than you normally walk every day.

You'll meet health guidelines by walking 10,000 steps daily and it's not bad advice for younger people or those who have more experience with a fitness regimen. But Lee said that for older peopleand those who are less fit, the so-called magicnumber is demoralizing. She notedthat for people who are inactive,setting too high a standard may discourage them from exercising entirely.

"If you're inactiveand your goal is to become more active, then set a reasonable goal," she said.

The average American, according to Lee, gets 4,000 to 5,000 steps every day.

Although the Department of Health and Human Services lists a 150-minutes-a-week requirement, it makes it clear that any physical activity no matter how slight is better than none.

Follow Joshua Bote on Twitter: @joshua_bote


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5 lessons one doctor learned from the times he almost died – WHYY

David Fajgenbaum was 25 years old the first time he almost died.

He was in his third year of medical school at the University of Pennsylvania. His goal was to become an oncologist an ambition born several years before, after watching his mother die from brain cancer.

In the summer of 2010, he was closer than ever before.

I was done with my book work and now finally treating patients in the hospital, he said. I was loving it, and I felt like I was finally achieving the things that I had been setting out to achieve and becoming a physician.

And then, out of nowhere, came the symptoms abdominal pain, lumps in his neck, fluid in his legs. But worse than anything was the insatiable fatigue, which eventually forced him to take micro-naps between each patient.

Finally, after struggling his way through an exam, Fajgenbaum went to the emergency department.

And thats when they did blood work and they informed me that my liver, my kidneys and my bone marrow were all shutting down, he said. I was hospitalized right away.

That was the beginning of a 3 -year saga, during which Fajgenbaum a former football player whom his friends had nicknamed The Beast would descend into an illness so great, so resistant to treatment, that it brought him to the brink of death no fewer than five times.

Eventually, Fajgenbaum was diagnosed with idiopathic Multicentric Castleman disease a rare illness that, at that time, had an expected survival rate of just a couple years.

I thought a lot about my mom, he said. I thought a lot about what it was like when she got such a bad diagnosis with her brain cancer. And it was terrifying.

Because its so rare, Castleman disease isnt well understood. That was especially the case 10 years ago. Fajgenbaum describes it as a cross between cancer and an autoimmune disease.

At its most basic sense, its just the immune system becoming hyper-activated and then attacking your vital organs for an unknown cause, he said.

Fajgenbaum sought out the worlds leading expert on Castlemans, and over the next couple of years, exhausted all known treatments for the disease.

He remembers the moment his doctor told him that the latest experimental drug wasnt working and that there were no more options left.

Within just a couple of minutes, I went from being this really optimistic Penn med student who was fighting cancer and who just hoped and prayed that this drug would work, to realizing that this drug was not going to work for me and that I was out of options, he said. And that I would need to start fighting back and start to try to identify drugs and treatments that could maybe help me and other patients.

So thats exactly was Fajgenbaum did. In between his relapses, he launched the Castleman Disease Collaborative Network, a nonprofit aimed at coordinating and pushing ahead research on the illness.

He also started doing his own research using himself as a subject. But before the projects could bear fruit, Fajgenbaum had another relapse, which attacked with terrifying speed.

Everything failing, fluid everywhere, organs shutting down, difficult to breathe just within days in the ICU, he said.

It was his closest brush with death, and offered a frightening wakeup call.

I was in denial I was like, it cant be a relapse, he said. I havent made enough progress yet. This cant be it I need more time.

He needed more time to find a cure but he also needed more time to live. By then, Fajgenbaum had become engaged, and was desperate to survive long enough to attend his own wedding.

This is when I realized that I needed to study my Castleman disease, he said. If I was going to make any progress for Castleman disease, for other patients, for all these patients around the world, I needed to survive.

So Fajgenbaum doubled down on his own personal research. He started poring through his own medical records, along with data from the experiments hed done on his own samples.

I knew I couldnt develop a new drug, he said. That would take 10 years and $1 billion. But maybe I could find something in my data that would suggest that something was wrong, where there was a drug that already exists that could target that thing.

After several weeks of intense work, Fajgenbaum found what he was looking for signs that his immune system had started gearing up for a fight as much as five months before his latest relapse.

Fajgenbaum speculated that if he could block the specific communication line that triggered that activation, called the mTOR pathway, maybe he could stop his immune system from overreacting and causing a relapse.

As it turns out, there was already a drug out there that does exactly that, called sirolimus.

This drug was dropped 30 years ago for kidney transplantation, Fajgenbaum said. It had never been used before for Castleman disease but I was out of options, and so I decided to try it on myself as the first patient with Castlemans.

As of January 2020, Fajgenbaum has been in remission for about six years though, even now, he counts his progress in months.

Today, its now been almost 71 months I think its like 71.92 months, he said. I cant round up; I dont know if Im going to make it to 72 months. But I also wont round down because we worked really, really hard for each portion of this remission.

He runs his own lab at the University of Pennsylvania dedicated to Castleman research, and helps lead the Penn Orphan Disease Center, in addition to continuing with the organization he founded, the Castleman Disease Collaborative Network.

He said he spends most waking hours either working on a cure for Castleman or with his wife, Caitlin, and their 15-month-old daughter, Amelia.

The fact that I have this disease is what has me working as hard as I do during the day, he said. Its what makes me spend so much time, as much as I can, with Caitlin and Amelia.

Hes forever conscious of the fact that he could relapse at any moment and that the drug thats kept him in remission isnt a cure for everyone. So far, research indicates that, like other Castleman treatments, it works for some patients, but not all.

That sense of urgency has transformed the way Fajgenbaum lives.

Its not just like, We have a certain amount of time, we need to make the most of it, he said. Its that if we can make the most of it, the way that I think we can in the lab and through our research, then we can actually make more time for me and for a lot of other people. And so its kind of like a race against the clock.

Its a stressful way to live but Fajgenbaums had good training.

I nearly died five times over the course of a 3 -year period after my diagnosis, he said. And with each of those near-death experiences, I learned a lot about life and about living.

Fajgenbaum recorded everything he experienced and learned in his recent memoir, Chasing My Cure. Here, he distills five of the lessons he gleaned one for each time he almost died.

Fajgenbaums first big lesson arrived after weeks of illness, when he was so close to death that the hospital sent in a priest to deliver his last rites.

I remember it being very dark, he said. I remember being pretty confused. But I remember seeing the priest and knowing somewhere in my brain what this meant.

Through the haze of his illness, the priests visit flipped a switch in Fajgenbaums brain. He was supposed to be dead, and the fact that he wasnt was a gift a chance to squeeze just a little more life from whatever time he had left.

Ive kind of considered that moment to be the start of my overtime, he said.

If you think about the Eagles or any sports team, you can make a mistake in the first quarter, and you can make up for it. But in overtime, you cant make a mistake. Every second truly has to count.

And in overtime, theres this profound sense of focus, where everything has to be so intentional and there can be no wasted movement, no wasted time.

Its a lesson, Fajgenbaum said, that everyone should take to heart.

I can appreciate being in overtime because of how close Ive come to death and because I can hear the clock ticking, he said. But I also appreciate and realize that we should all live like were in overtime.

It was during another brush with death that Fajgenbaum had an epiphany: I realized I didnt regret anything that I had done or I had said. I only regretted the things that I had not done or had not said and would not be able to do.

Specifically, at that moment, Fajgenbaum regretted losing his girlfriend, Caitlin. The two of them had broken up six months before, when work and school forced them to go long-distance.

When we broke up, we both looked at one another and we said, You know, if its meant to be, itll work out. We have all the time in the world, Fajgenbaum said. And then, there I was, dying in a hospital bed, and realizing I didnt have any more time.

As soon as he was well enough, Fajgenbaum got in touch with Caitlin, and the two reunited.

The experience imprinted on Fajgenbaum the importance of action.

I had this really profound sense that, moving forward if I survived I would not just think about things, he said. If I was thinking about it, I should do it.

It led to one of Fajgenbaums life mottos: Think it, do it.

Around the time of Fajgenbaums third relapse, his father came to visit him in the hospital.

He was feeling better after high-dose chemotherapy, but looking the worse for wear. He was bald from the treatment, and had accumulated pounds of fluid around his middle because his liver and kidneys had stopped working.

But on that New Years Eve, he was feeling well enough for a walk around the hospital. On one of their laps, Fajgenbaum and his father encountered a drunk guy in the waiting room.

He was kind of like swaying in his chair, Fajgenbaum said.

On their next lap around, they found that the man had fallen to the floor.

And so my dad ran over and helped him back into his chair, Fajgenbaum said. And he looked at my dad and I, and he said, Thanks so much. Good luck to you and your wife. And I was like, `What is he talking about? And I looked at my belly, and I realized he thought I was my dads pregnant wife. And so I turned to my dad, I said, Dad, youve got an ugly wife! And the two of us just burst into laughter.

Only a few months before, Fajgenbaum said, he wouldnt have been able to laugh at something like that. But the more he learned about his own resilience, the more important humor became.

I think laughing in the face of death and disease is kind of the last thing that you think that you would want to do, he said. But actually, it kind of gave me like a sense of like, I dont know if it was like power over the disease, that like, Yes, disease. I know youre awful. I know youre killing me, and I know youre making me get chemotherapy and youre even making me look like a pregnant woman. But Im going to laugh with my dad, and this is going to be something that well never forget that time when this guy thought that I was, you know, my dads pregnant wife. And even though the disease was clearly winning, it made me feel like I was like doing something to fight back.

It took finding out that he was out of options that made Fajgenbaum decide to take matters into his own hands.

After finishing medical school, he attended the prestigious Wharton School of business at the University of Pennsylvania, and launched the Castleman Disease Collaborative Network an organization designed to push forward the search for treatments.

He also started doing his own research, using himself as a subject.

For years, hed put his trust in the medical powers that be. But desperation made him realize that if he wanted a cure, he might have to find it himself.

The concept of turning hope into action is probably the thing thats made the biggest impact on my life, he said. I was a very hopeful person before I became ill. I believed that there was kind of an order to things. I just felt like, if it was important, that it would be done by someone somewhere. But Ive since learned that if its something that Im hoping for, or something that I or someone else is praying for, that we should figure out ways to actually make that a reality.

With the Castleman Disease Collaborative Network, Fajgenbaum had put into motion a project that united researchers from around the world, and enlisted some of medicines finest minds to move the ball forward.

In general, developing new medications can take years and millions of dollars. But in the end, Fajgenbaum found his very own cure in a medication thats stocked in pharmacies on every corner.

With this fifth time I nearly died, I think the biggest lesson that I took from it is that solutions can sometimes be hiding in plain sight, he said. How many other drugs are there out there? How many other solutions are there out there for diseases and for other industries where they already exist? Just someone has to find it.

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5 lessons one doctor learned from the times he almost died - WHYY

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