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ate heat and keep the body warm. “What if we could increase the amount or thermogenic activity of a patient’s brown fat?” Reynolds asks. In theory, the patient would burn off much of the energy stored in white fat cells, so those fat cells would shrink and the person would lose weight. He also points to relat-

ed research identifying one of the substances generated by muscle con- tractions as a hormone- like protein called irisin, which “can make white fat ‘browner’—that is, more metabolically ac- tive, more thermogenic.” Certainly exercising is healthy and burns calo- ries, but Reynolds says muscle use produces a wide range of effects— often including increased appetite—that may bal- ance or counteract the irisin release. Extracted irisin could turn out to be useful in, or as, a future anti-obesity medication. Yet another avenue is

stem-cell therapy. Since brown fat cells begin as the same stem cells that produce muscles but then differentiate during embryonic development, Reynolds explains, “we could potentially figure out how to culture these stem cells to become brown fat cells and then inject them into a patient.” As with any really safe, really effective obesity treatment, of course, “the implications for health, and for health care costs, would be huge.”

“Care Coordination has got to improve, and I’m opti- mistic that it will,” Crystal Moore declares. Specialists who don’t communicate with each other, family care-givers left out of the loop, factors that medical personnel don’t even know about— these are big issues in geriatrics especially. And geriatrics itself is big, because the number of US citizens over the age of 65, now at 40 million, will explode to 72 million by 2030, Moore reports. An office visit with an elderly patient typically takes longer and may involve fewer reimbursable procedures. If the geriatri- cian wants to talk with one or two of the patient’s specialists, that phone time isn’t billable. At the same time, Moore cites studies showing that several key factors in older adults’ hospi- tal readmission rates aren’t even medical—such as marital sta- tus, race, and income. This is where comprehensive care teams show real promise,

she says. When care is planned and delivered by a group includ- ing, say, a visiting nurse, a social worker, a physical therapist, and a geriatrician, health and wellness improve and costs de-

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cline. Her research finds that elderly patients at Veterans Ad- ministration clinics using such coordinated care strategies do not have different readmission rates according to race or class; the integrated approach is more equitable, and communica- tions are better with the VA’s “incredibly good electronic med- ical-records system.” When a team gets pay incentives for good outcomes rather than reimbursements for each test or procedure, she adds, everybody wins. Moore says, “America is

finally waking up to the fact that health care is a scarce resource. And the baby boomers who will be its main consumers tend to have high expectations and demands. Today’s fragmented fee-for- service health care market- place won’t be sustainable much longer.”

home pregnanCy tests are so yesterday. Com- ing soon are far smaller kits for far more complex bio- medical testing; in fact, such lab-on-a-chip technology is already in use. Kim Frederick

and her peers around the world have been developing plastic chips, smaller than credit cards, and etching into them thinner- than-hair channels and tiny wells to hold droplets of blood, urine, or other liquid. The researchers are also optimizing con- centration and filtering methods and fine-tuning ways of stimu- lating the fluids to flow through the etched capillaries into the testing stations laid out on each chip. In disaster zones or other unequipped locations, as well as in

kitchens and bathrooms, a wide array of tests—say, for air- or food-borne toxins or for any number of medical conditions—are now and will be increasingly doable on chips. One application of this technology is for diagnosing malaria: instead of a micro- scopist peering at a blood smear on a slide to look for malaria parasites after the patient is already dangerously sick, Frederick says, a chip device can quickly identify d-lactate, which is pro- duced by the parasites and is detectable very early in the infec- tion. Frederick’s own lab is working on food-allergy screening. “Life-threatening food allergies have increased dramatically in recent years,” she says, and “unfortunately, the best tests still in- volve taking multiple vials of blood from a screaming child.” But soon multiple allergy screenings could be done with just one drop of blood in a little plastic chip. Analytical chemistry labs like Frederick’s are working on im-

provements (some are even trying waxed paper instead of plastic for affordability) that could revolutionize medical testing and enhance health care both here and abroad.

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