Yearly Archives: 2015

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With almost 70 percent of the U.S. population overweight or obese, it’s no surprise that the number one New Year’s resolution each year is to lose weight. Now that you or someone you know has made this resolution, what are you going to do about it?
Roughly 50 percent of people make New Year’s resolutions, and 71 percent of people maintain their resolve for the first two weeks. In six months, about half are still working toward their goals, at least to some degree. So about half of us make resolutions and about half of us stick to them at least halfway through the year (1). The good news is that people who make resolutions are about 10 times more likely to reach their objectives than those who don’t (2). So don’t give up!
Wouldn’t it be nice if we had a silver bullet that would help us lose weight without much thought? Are diet pills at least part of the answer? Diet pills, both medications and supplements, have a checkered past. But don’t despair, the armament of diet pills is beginning to grow. Two drugs were approved in 1999: Xenical (orlistat) and Meridia (sibutramine). Meridia was subsequently withdrawn due to side effects. Since then, the options have expanded with the 2012 approval of two additional drugs: Qsymia (phentermine-topiramate combination) and Belviq (lorcaserin). And finally, we have two new medications, approved in the latter half of 2014: Contrave (naltrexone-buproprion) and Saxenda (liraglutide). At this point, you need a playbook to keep them straight.
How do we evaluate weight-loss drugs? There are two important parameters: effectiveness in weight loss and impact on health. Drugs considered modestly effective cause at least 5 percent weight loss. Those that cause 10 percent weight loss are considered very good. Those that cause over 15 percent weight loss are considered excellent.
Let’s look at the history of diet drugs, along with evidence on the two newest entrants.
Unfortunately, diet pills’ track records have made both the medical community and the population at large leery. One of the most notorious medications was Fen-phen (fenfluramine-phentermine combination). While this drug combination helped people lose weight, it also had some serious side effects, pulmonary hypertension and heart valve defects resulting in serious adverse events and even mortality in some patients who took the drug. It was withdrawn from the market in 1997 by the FDA (3). Fenfluramine was blamed for causing these side effects, not phentermine. The reason I highlight this is that another more recent combination uses phentermine.
In terms of supplements, green coffee bean extract had been touted for its weight-loss capabilities based on a small 2012 study funded by the manufacturer (4). However, the FTC took this study to task, noting that the lead investigator changed the weights of patients, altered the length of the trial and could not determine which patients actually took supplement or placebo. In 2014, the journal responsible for publishing the research retracted the results (5).
This brings up another point. Green coffee bean supplements were promoted on a TV medical talk show. A recent study looked at the validity of advice given on these shows. Research evidence that supported the shows’ claims was found only half the time, and it was usually only from small studies or case studies. Unfortunately, the magnitude of benefit, the side effects, conflicts of interest and costs were highlighted on the shows no more than 20 percent of the time (6). So caveat emptor or, as “The Doctors” show says many times, consult your physician.
There have been two established drugs since 1999: Xenical (orlistat) and Meridia (sibutramine). In a meta-analysis (a group of 14 randomized controlled trials, 11 with orlistat and 3 with sibutramine), results showed that there was a mean reduction in weight of 2.9 percent with orlistat and 4.6 percent with sibutramine (7). Also, there were only 12 percent of patients on orlistat and 15 percent of patients on sibutramine who achieved greater than 10 percent body weight reduction when compared to placebo. To boot, both drugs have side effects. Orlistat is known for causing gastrointestinal (GI) side effects.
Another smaller trial with Alli (orlistat over the counter) found that those who followed diet and exercise regimens while taking the drug saw a median 5 percent reduction in weight over a two-month period. The patients were satisfied or very satisfied with the results, despite GI side effects after three months of study duration (8).
Orlistat assessment: modest efficacy and mild-to-moderate side effect profile.
Sibutramine was taken off the market in 2010 due to increased risk of cardiovascular events (3).
Two drugs are recent enough that they don’t have track records in the marketplace. In September 2014, Contrave (naltrexone-bupropion) was approved by the FDA (3). In a large randomized controlled phase 3 trial, naltrexone-bupropion demonstrated significant effectiveness over placebo (9). The mean weight lost was 5.0 percent in the low-dose drug and 6.1 percent in the high-dose drug, whereas the placebo demonstrated a 1.6 percent reduction. These results were seen over 56 weeks. Nausea was the most common side effect, occurring in 30 percent of patients. The drug did also raise blood pressure 1.5 mmHg initially. There is an ongoing study intended to demonstrate no increased risk of heart attack, and interim results have been good.
There is a black box warning that patients may have suicidal thoughts because of bupropion, an antidepressant. Ultimately, Contrave reduces weight by an additional 4.1 percent over placebo (3). This medication can be used for those who are obese (BMI>30 kg/m2) or who have a BMI>27 kg/m2 with an additional weight-related disease, such as diabetes or high blood pressure.
Naltrexone-bupropion assessment: modest effectiveness and mild-moderate potential side effect profile. If the drug does not reduce the weight when using maintenance dose by at least 5 percent in 12 weeks, it should be discontinued according to the FDA (3).
The latest drug, Saxenda (liraglutide), was approved in December 2014. In a randomized controlled trial with a 56-week duration, liraglutide resulted in a 6.2 percent reduction in weight, whereas the placebo had 0.2 percent reduction in weight (10). Interestingly, the researchers required that all participants have a pre-trial period of lifestyle modifications, which resulted in a 6 percent weight loss prior to the trial. The treatment population is the same as for naltrexone-bupropion, either obese (BMI>30 kg/m2) or a BMI>27 kg/m2 with an additional weight-related disease, such as diabetes or high blood pressure. Liraglutide is an injectable diabetes drug in the class referred to as GLP-1 agonists. The dose is higher for weight-loss patients. The side effect profile was mainly associated with GI distress.
Liraglutide assessment: modest effectiveness and mild side effect profile.
Interestingly, metformin has been used as an off-label weight-loss drug as well, meaning not approved by the FDA for that use, but at the discretion of the physician.
Your best recourse is always lifestyle changes, but a diet drug could help jump start your resolution to lose weight. The medications have very similar modest effectiveness and mild-to-moderate side effect profiles. However, the newer drugs do not have post-marketing safety data yet. Even if you start a diet medication, diet and exercise are highly recommended or else the results may not be achieved with medication alone. I can’t stress it enough: always consult your doctor before starting a weight-loss drug.
(1) (2) J Clin Psychol. 2002 Apr;58(4):397-405. (3) (4) Diabetes Metab Syndr Obes. 2012;5:21-7. (5) Diabetes Metab Syndr Obes. 2014;7:467. (6) BMJ. 2014;349:g7346. (7) Int J Obes Relat Metab Disord. 2003;27:1437-1446. (8) Obesity (Silver Spring). 2008;16:623-629. (9) Lancet. 2010;376:595-605. (10) Int J Obes (Lond). 2013;37:1443-1451.

Dr. Dunaief is a speaker, author and local lifestyle medicine physician focusing on the integration of medicine, nutrition, fitness and stress management.  For further information, go to the website and/or consult your personal physician.

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When he was 15, Raju Venugalapan spent what was then a considerable sum of money to buy three books on what his parents thought was an obscure subject. Living in India, where he was born and raised, Venugalapan bought the Feynman lectures, books that were based on lectures delivered to students at the California Institute of Technology by Nobel laureate Richard Feynman. These lectures were designed to make physics more vibrant and inspirational.

The books worked for Venugalapan, who was determined to enter the field of physics. The would-be physicist, however, had a problem — his parents weren’t sure this represented a viable career choice. For them, studying physics was like writing poetry, he said. While it might have value, it could be difficult to earn a living and support a family.

His parents’ opinion changed, however, when he received a full scholarship to study physics at the University of Chicago.

Over a quarter of a century later, Venugalapan is a senior scientist and group leader of the Nuclear Theory Group in the Physics Department at Brookhaven National Laboratory.

“I love getting up in the morning and going to work,” said Venugalapan. His daily pursuits are something that are “very natural to me, like breathing.” What makes his work so exciting, Venugalapan said, is that he can address questions about some of the unknown structural elements of matter.

“I see various data as pieces of a jigsaw puzzle that, together with theoretical insight, can provide a larger picture of the sub-nuclear scale matter,” he explained.

Larry McLarren, a senior scientist and a group leader at the Riken BNL Center, said Venugalapan’s approach and theories have proven successful.

“He’s developed many of the ideas that are hot right now,” he said. Venugalapan is “somebody who has done a lot of good work and is full of energy.”

Venugalapan studies data that comes out of the Relativistic Heavy Ion Collider at BNL, where scientists collide protons and neutrons almost to the speed of light. The heat generated from these collisions is 100,000 times hotter than the center of the sun, although they last for an unimaginably small amount of time.

Feynman — the physicist who inspired Venugalapan — described this process as being similar to smashing two Swiss watches together. At this point, he said, “we don’t have the luxury of taking apart” subatomic particles such as gluons and quarks.

A few years ago, he and his colleagues had developed a theory about the correlations of gluons and how they would behave. One of the team members made a prediction for proton-proton collisions at the Large Hadron Collider near Geneva, Switzerland.

Because the signal was too small, the group published its result as a curiosity in a conference proceeding rather than in a scientific journal. When the LHC experimentalists found this phenomenon, Venugalapan and his team were able to put out a paper within a week of the announcement.

The event they described was about a one in a million occurrence in a proton-proton collision. “It was extremely exciting,” he recalled. “It was the biggest high you can imagine.”

After the original result, the science progressed as it often does in the face of new information and a new theory: Other researchers performed similar experiments to confirm the data — and to test the idea behind it.

“I’d go to bed at night with a mixture of anticipation and trepidation,” Venugalapan said. There might be a new paper out that “either killed or confirmed our idea.”

Venugalapan and his colleagues believed there could be two phenomena that could cause the effect: One was hydrodynamics and the other was a so-called quantum synchronicity of gluons.

A resident of Riverhead, Venugalapan enjoys sailing with his family on Peconic Bay. As for his work, Venugalapan said he still marvels at how the theories he and his colleagues create might describe events at a subatomic level.

“When you’re making up these mathematical edifices, there’s a certain level of disbelief that this can describe the world,” he said. “We’re playing with paper and equations and, on the other side of the world, there’s a 15-ton detector” that’s running experiments. He wonders: “What do my scribbles have to do with what they see there?”

As for his parents, he said they had a point: “The creative process in science and theoretical physics in particular is not unlike that in poetry.”

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By Linda M. Toga, Esq.

I generally do not revisit a topic if I have discussed it in a prior article. However, based on the number of phone calls I’ve received from clients in response to alarming solicitations they’ve received in the mail, I am making an exception this month.

It has been almost three years since I first warned readers about a scam involving unscrupulous companies that scared property owners into purchasing unnecessary certified copies of their deeds at inflated prices ranging from $59 to $129. Unfortunately, the companies behind the scam are still at it. In fact, the problem has apparently become so widespread that the Suffolk County Clerk recently sent a letter to property owners advising them that there was no immediate need to purchase certified copies of their deeds.

My original article which includes information on how to obtain a certified copy of the deed to your property in the unlikely event you need one, follows. While this article deals exclusively with deeds, there is a lesson to be learned here that applies to all types of legal documents. If you are asked to send money or to take some other type of action in connection with a contract, power of attorney, deed, lease or license, to name a few, it is best to consult an experienced attorney before you act. Scams like the one discussed here are only successful when people make uninformed choices. So please, get expert advice before you act in such matters.

The Facts: I recently received a letter from a company suggesting that I should have a certified copy of my deed. The company offered to get the deed for me for about $85.

The Question: Is this a scan?

The Answer: Yes, it is a scam and one that is quite lucrative for the company making the offer. The reason it is a scam is that most people will never need a certified copy of their deed. In the unlikely event a property owner needs to produce a certified copy of a deed, they can easily obtain one either in person or by mail for a fraction of what the company is charging. Although companies like the one that sent you the letter often refer to an article published by the Federal Citizen Information Center (“FCIC”) to convince property owners that they must have a certified copies of their deeds, it is noteworthy that the FCIC website contains a warning about the deceptive practices of companies that send mass mailings like the one you received to unsuspecting property owners.

How It Works: When you purchased your property, the original deed signed by the seller should have been forwarded to the county clerk for recording. Once the deed was recorded in the county land records, the original deed would have been returned to you, as the new property owner, or to your attorney. If, for some reason, the original deed was not returned to you or your attorney, or if it has been lost, you can obtain a copy of the deed from the county clerk in the county where your property is located. For property in Suffolk County, you can call the Suffolk County Clerk’s Office at 631-852-2000 for information on how to obtain a copy of your deed. If, in fact, you do need a certified copy of your deed, the county clerk can also provide you with a certified copy of your deed. Rather than paying the $85 charged by some private companies, you will only have to pay the county clerk about $5.00, including postage and handling, to get a certified copy of a deed up to 4 pages long.

Linda M. Toga, Esq. provides legal services in the areas of litigation, estate planning and real estate from her East Setauket office.

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From finding prehistoric groundhog-like creatures to fostering mutations that help tomato plants produce more fruit to doubling the understanding of what causes a proton to spin, scientists on Long Island, working with teams from around the world, had a busy, productive and, in some cases, lucky year in 2014.

Experts from all three local institutions made waves well beyond their scientific peers, as their papers in Science, Nature to the Proceedings of the National Academy of Sciences generated headlines around the world.

While the researchers at Stony Brook University, Brookhaven National Laboratory and Cold Spring Harbor Laboratory answered important questions in their fields, they consider the achievements of the past year a starting point for the next set of questions, experiments and opportunities.

Times Beacon Record Newspapers will take a look back at the remarkable achievements, findings researchers working in our communities enjoyed in 2014.

Stony Brook
A long time ago on an island far, far away, a 20-pound mammal walked with dinosaurs, including the carnivorous 2,400-pound Majungasaurus. This mammal, which is much larger than the mammals that were mostly the size of shrews and rats at that time, was hidden in a 150-pound slab of sandstone for over 66 million years in Madagascar. That is, until David Krause, a distinguished service professor in the Department of Anatomical Sciences, and his graduate students brought back the creature.
Krause was fishing through the block for, well, fossil fish, but instead stared into the face of an unknown chapter in ancient history. Removing one grain of sand at a time, Krause and his colleagues spent six months extricating the extraordinary find. They named the mammal Vintana sertichi. Vintana comes from the Malagasy word for “luck,” because they had no idea what awaited them in the heavy rock. “It’s good to have strong graduate students,” Krause said.
On the same island nation of Madagascar, Patricia Wright had a year that would make the lemurs she studies and considers her extended family howl. Only two years after opening a state-of-the-art, five-story research facility called Namanabe Hall on the boundary of Ranomafana National Park, Wright and her research were featured in an Imax movie called “Island of Lemurs: Madagascar.” As if that weren’t enough, Wright became the first female scientist to win the top award in conservation: the Indianapolis Prize, which included a $250,000 cash gift.
Meanwhile, ecologist Heather Lynch used satellite images to study penguin poop in Antarctica. Lynch and Michelle LaRue from the University of Minnesota estimated that the population of Adelie penguins was considerably larger than expected. While some conservationists suggested such a result might run counter to concerns raised by global warming, Lynch said the story was more complicated than the overall number, with groups declining in some areas and increasing in others.
Studying temperatures that would make those in the Antarctic seem balmy by comparison, researchers in the Department of Physics and Astronomy sought to understand properties of metallic materials as they approached absolute zero. Liusuo Wu, a doctoral student, Moosung Kim and Keeseong Park worked with Professor Meigan Aronson to explore the start of ferromagnetism, which is the same property in electrical motors or refrigerator magnets, in a specially made iron compound near this extremely cold temperature.
Exploring the quantum phase transition allows researchers to predict and possibly boost the performance of new materials in practical ways that had previously been theoretical, explained Brookhaven Lab physicist Alexei Tsvelik, a co-author on the study.
Looking at how life copies itself on the genetic scale, Huilin Li, a professor of biochemistry and cell biology at Stony Brook and a biologist at BNL, teamed up with researchers from BNL and Cold Spring Harbor Laboratory. The group found structural details of an enzyme that unzips and splits the double helical DNA into two halves. This, Li explained, may help researchers explore how that process can go wrong and may one day lead to new treatments that stall or break runaway genetic machinery. The findings came from a close collaboration with lead author Jingchuan Sun at BNL, Bruce Stillman at CSHL and Christian Speck at Imperial College, London.

Cold Spring Harbor Laboratory
At CSHL, scientists made strides in gathering information about human diseases, like schizophrenia, Alzheimer’s and cancer. They also developed a new genetic toolkit for growing more productive tomato plants.
Looking at de novo mutations in a broader range of diagnoses, including schizophrenia, autism and intellectual disabilities, W. Richard McCombie and Shane McCarthy found overlapping genes. Some of these genes are involved in reading, writing and editing chemical marks on DNA and proteins that help control when specific genes are switched on or off. It is possible, a group that includes professor Aiden Corvin of Trinity College speculates, that the genes that affect the same biological function in some disorders are examples of those that contribute to normal brain development.
Associate Professor Bo Li, meanwhile, helped identify neurons that actively participate in fear conditioning. By studying a group of long-range neurons that extend from the central amygdala to an area of the brainstem called the midbrain periaqueductal gray in an animal model, he discovered a neural circuit that connects the site of fear memory with a part of the brainstem that controls behavior. His work could have applications to models of post-traumatic stress disorder.
Also studying the brain, Associate Professor Adam Kepecs asked rats how confident they were in their decisions. Designing experiments that required rodents to wait for a reward, Kepecs was able to show that a part of the brain called the orbitofrontal cortex plays a role in confidence and decision making. Animals with a blocked orbitofrontal cortex made decisions just as effectively, but their confidence, even with incorrect choices, remained high even when they didn’t get their desired reward.
Using a mouse model for prostate cancer, Associate Professor Lloyd Trotman studied the genetics of a disease that afflicts one in six men. In these mice, the typical driver of prostate cancer, PI 3-kinase, was absent in metastasized tumors. Instead, he and colleagues from Weill Cornell Medical College, Mt. Sinai School of Medicine and Dana-Farber Cancer Institute discovered that a cancer gene called Myc had become active. By lowering the amount of Myc in cells, they shrunk the metastases. Trotman hopes the model provides a fast and faithful way to test new approaches to find a cure for what is up to now an incurable disease.
Finally, associate professor and tomato expert Zachary Lippman, working with colleagues in Israel, discovered a genetic toolkit that allows researchers to double fruit production. The team found a collection of new gene mutations that allow scientists, and potentially farmers, to fine-tune the balance between the hormones florigen and anti-florigen. This has the potential to maximize fruit production without compromising the energy leaves need to support the fruit.
In the bigger picture, scientists at all three institutions showed considerable excitement for discoveries in the year, and years, ahead. Tribble pointed to the opening of the National Synchrotron Light Source II, the next-generation light source that cost about $900 million to build and that will provide images that are 10,000 times brighter than the original NSLS.
“NSLS II is poised to have some phenomenal information coming out,” Tribble said. “We can set a big battery in the beam and watch what’s happening” inside the battery without taking it apart.
At Stony Brook, the past year was “notable for the huge potential related to imaging,” said Lina Obeid, the dean for research at the Stony Brook Medical School. She said the university, with the construction of the new Medical and Research Translation building is “poised to have lots of great ideas and strong data.”
Cold Spring Harbor Laboratory is celebrating its 125th anniversary next year. Bruce Stillman, the president and CEO, said he hopes 2015 “will be a big year for expanding opportunities to apply our basic research to the medical clinic and other areas like food production and biofuels.”

Brookhaven National Laboratory
Scientists at BNL explored everything from the origins of the universe to nanoscale — i.e., very small — reactions in electric car batteries, to processes even more rare than the recently discovered Higgs boson, to increasing the production of oil in plants.
“It’s an enormously exciting time at BNL right now,” said Bob Tribble, the deputy director for science and technology, who joined the research center in February. A nuclear physicist, Tribble highlighted several studies that have broader implications.
Over the last decade, researchers could only account for a third of what gives a proton — that positively charged particle in the nucleus — its spin. As recently as six years ago, researchers believed subatomic particles called gluons had only a small effect. Now, “it’s clearer that the gluon field is playing a significant role in developing that spin,” Tribble said. Indeed, Elke Aschenauer, a leader in the spin program at the Relativistic Heavy Ion Collider, in collaboration with researchers at Star and Phenix, benefited from accelerator advances and added running time to collide polarized protons. The knowledge of gluon’s larger role in a proton’s spin, which no one had measured conclusively until now, could not only provide a better awareness of the internal structure of particles but could also affect optical, magnetic and electrical properties.
Scientists at the RHIC also learned about the phase transition of matter. Say what? Yes, that’s the equivalent of ice turning into water, although at a subatomic level. Zhangbu Xu, a spokesperson for RHIC’s Star collaboration, said RHIC provides the ability to explore what happens over a wide range of collisions. As Tribble put it, “now that we’ve been able to probe in some different regimes of the phase diagram, we’re seeing evidence that the first-order phase transition occurs in certain parts of the phase diagram. That’s new.”
Meanwhile, physicists at the ATLAS experiment at the Large Hadron Collider continue to test the Standard Model of particle physics. To do that, they are looking for incredibly rare events, where two same-charged particles called W bosons scatter off one another. Physicist Marc-Andre Pleier studied 34 such events that confirm that the Higgs boson particle does what physicists predicted.
In the world of superconductivity, senior physicist and director of the DOE’s Center for Emergent Superconductivity at BNL J.C. Seamus Davis helped lead a team that showed how electrons in a pseudogap are less free to move than they are in their superconductive state. By understanding these gaps, the team may be able to conduct the kind of science that leads to the speeding up of efficient power generators and transmission and computers at levels more than thousands of times faster than the machines currently in use.
John Shanklin, Jilian Fan and Changcheng Xu didn’t build a better mousetrap, but they did figure out how to encourage the development of a better plant, at least in the world of biofuel. The researchers found the detailed biochemical steps in the breakdown of oils. They disabled an enzyme that breaks down oil droplets to release fatty acids. The result was a 150-fold increase in oil content compared to the leaves of the naturally occurring counterpart. This could enhance production of biofuels.