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kmaherali
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November 20, 2009
News Analysis
Screening Debate Reveals Culture Clash in Medicine
By KEVIN SACK

This week, the science of medicine bumped up against the foundations of American medical consumerism: that more is better, that saving a life is worth any sacrifice, that health care is a birthright.

Two new recommendations, calling for delaying the start and reducing the frequency of screening for breast and cervical cancer, have been met with anger and confusion from some corners, not to mention a measure of political posturing.

The backers of science-driven medicine, with its dual focus on risks and benefits, have cheered the elevation of data in the setting of standards. But many patients — and organizations of doctors and disease specialists — find themselves unready to accept the counterintuitive notion that more testing can be bad for your health.

“People are being asked to think differently about risk,” said Sheila M. Rothman, a professor of public health at Columbia University. “The public state of mind right now is that they’re frightened that evidence-based medicine is going to be equated with rationing. They don’t see it in a scientific perspective.”

For decades, the medical establishment, the government and the news media have preached the mantra of early detection, spending untold millions of dollars to spread the word. Now, the hypothesis that screening is vital to health and longevity is being turned on its head, with researchers asserting that mammograms and Pap smears can cause more harm than good for women of certain ages.

On Monday, the United States Preventive Services Task Force, a federally appointed advisory panel, recommended that most women delay the start of routine mammograms until they are 50, rather than 40, as the group suggested in 2002. It also recommended that women receive the test every two years rather than annually, and that physicians not train women to perform breast self-examination.

The task force, whose recommendations are not binding on insurers or physicians, concluded after surveying the latest research that the risks caused by over-diagnosis, anxiety, false-positive test results and excess biopsies outweighed the benefits of screening for women in their 40s. It found that one cancer death is prevented for every 1,904 women ages 40 to 49 who are screened for 10 years, compared with one death for every 1,339 women from 50 to 59, and one death for every 377 women from 60 to 69.

On Friday, the American College of Obstetricians and Gynecologists plans to announce a similar revision to its screening guidelines for cervical cancer. It will advise that women receive their first Pap test at age 21; the previous standard had been three years after a woman’s first sexual intercourse or age 21, whichever came first. The group also is recommending that the test be performed every two years instead of annually for women ages 21 to 30.

“A review of the evidence to date shows that screening at less frequent intervals prevents cervical cancer just as well, has decreased costs and avoids unnecessary interventions that could be harmful,” said Dr. Alan G. Waxman, a professor at the University of New Mexico who directed the process.

The challenge of persuading patients and doctors to accept such standards requires a transformational shift in thinking, particularly when the disease involved is as prevalent, as deadly, and as potentially curable as cancer. How do you convince them that it is in their best interest to play the odds when they have been conditioned for so long to not gamble on health? After all, for the one in 1,904 women in their 40s whose life would be saved by early detection of breast cancer, taking the risk would in retrospect seem a bad choice.

“This represents a broader understanding that the efforts to detect cancer early can be a two-edged sword,” said Dr. H. Gilbert Welch, a professor of medicine at Dartmouth who is among the pioneers of research into the negative effects of early detection. “Yes, it helps some people, but it harms others.”

Dr. Welch said this week’s recommendations could mark a turning point in public acceptance of that notion. “Now we’re trying to negotiate that balance,” he said. “There’s no right answer, but I can tell you that the right answer is not always to start earlier, look harder and look more frequently.”

That concept is proving easier to swallow in the halls of Dartmouth Medical School than in the halls of Congress. Coming as they did at the height of debate over a sweeping health care overhaul, the recommendations have provided fresh ammunition for those who warn that greater government involvement in medical decision-making would lead to rationing of health care. It has not mattered that the breast cancer screening recommendation is only advisory, and that the federal government, the American Cancer Society, and numerous private insurers have said they will not adopt it.

Senator Kay Bailey Hutchison, a Republican who is running for governor of Texas, cited the task force’s screening statistics in a floor speech on Thursday. “One life out of 1,904 to be saved,” Ms. Hutchison said, “but the choice is not going to be yours. It’s going to be someone else that has never met you, that does not know family history.” She added, “This is not the American way of looking at our health care coverage.”

The health care bills in both the House and the Senate would establish commissions to encourage research into the effectiveness of medical tests and procedures, but would not require that the findings be translated into practice or reimbursement policies.

As throughout history, it may take decades for medical culture to catch up to medical science. Dr. Rothman pointed out that it took 20 years for the public to accept the discovery in 1882 that tuberculosis was caused by a bacterium and not by heredity or behavior. More than 160 years after the Hungarian-born physician Ignaz Semmelweis posited that hand-washing could prevent the spread of infectious disease, studies still show that half of all hospital workers do not follow basic hygiene protocols.

“It’s going to take time, there’s no doubt about it,” said Louise B. Russell, a research professor at the Rutgers University Institute of Health who has studied whether prevention necessarily saves money (and found it does not always do so). “It’s going to take time in part because too many people in this country have had a health insurer say no, and it’s not for a good reason. So they’re not used to having a group come out and say we ought to do less, and it’s because it’s best for you.”

This article has been revised to reflect the following correction:

Correction: November 21, 2009
A news analysis article on Friday about recommendations that women should delay screenings for breast and cervical cancer misstated a statistic from the United States Preventive Services Task Force, which released the breast cancer recommendations. The task force concluded that one cancer death was prevented for every 1,339 women aged 50 to 59 who were screened for 10 years — not 50 to 74.

http://www.nytimes.com/2009/11/20/healt ... nted=print

******
November 20, 2009
Op-Ed Contributor
Addicted to Mammograms
By ROBERT ARONOWITZ
Philadelphia

THE United States Preventive Services Task Force’s recommendation this week that women begin regular breast cancer screening at age 50 rather than 40 is really nothing new. It’s almost identical to the position the group held in the 1990s.

Nor is the controversy that has flared since the announcement something new. It’s the same debate that’s gone on in medicine since 1971, when the very first large-scale, randomized trial of screening mammography found that it saved the lives only of women aged 50 or older. Despite the evidence, doctors continued to screen women in their 40s.

Again in 1977, after an official of the National Cancer Institute voiced concern that women in their 40s were getting too much radiation from unnecessary screening, the National Institutes of Health held a consensus conference on mammography, which concluded that most women should wait until they’re 50 to have regular screenings.

Why do we keep coming around to the same advice — but never comfortably follow it? The answer is far older than mammography itself. It dates to the late 19th century, when society was becoming increasingly disappointed, pessimistic and fearful over the lack of medical progress against cancer. Doctors had come to understand the germ theory of infectious disease and had witnessed the decline of epidemic illnesses like cholera. But their efforts against cancer had gone nowhere.

In the 1870s, a new view of the disease came to be developed. Cancer had been thought of as a constitutional disorder, present throughout the body. But some doctors now posited that it begins as a local growth and remains so for some time before spreading via the blood and lymph systems (what came to be understood as metastasis).

Even though this new consensus was more asserted than definitively proved by experimental evidence or clinical observation, it soon became dogma, and helped change the way doctors treated cancer. Until this time, cancer surgery had been performed only rarely and reluctantly. After all, why remove a tumor, in a painful and dangerous operation, when the entire body is diseased?

The new model gave doctors reason to take advantage of newly developing general anesthesia and antiseptic techniques to do more, and more extensive, cancer surgery. At the turn of the 20th century, William Halsted, a surgeon at Johns Hopkins, promoted a new approach against breast cancer: a technically complicated removal of the affected breast, the lymph nodes in the armpit and the muscles attached to the breast and chest wall.

Doctors widely embraced Halsted’s strategy. But they seem to have paid little attention to his clinical observations, which indicated that while the operation prevented local recurrence of breast tumors, it did not save lives. As Halsted himself became aware, breast cancer patients die of metastatic, not local, disease.

By 1913, the surgeons and gynecologists who started the American Society for the Control of Cancer (later the American Cancer Society) had begun an anti-cancer campaign that, among other things, advised women to see their doctors “without delay” if they had a breast lump. Their message promoted the idea that if cancer was detected early enough, surgery could cure it.

This claim, like the cancer theory it was built on, was based on intuition and wishful thinking and the desire to do something for patients, not on detailed evidence that patients were more likely to survive if their cancer was caught early and cut out. But it did create a culture of fear around breast cancer, and led the public to believe that tumors needed to be discovered at the earliest possible moment.

The “do not delay” campaign reached its heyday in the 1940s, when through lectures, newspaper articles, posters and public health films, doctors exhorted people to survey their bodies for cancer warning signs like breast lumps, irregular bleeding and persistent hoarseness. This campaign generated greater fear, which led to more demand for some means to gain a sense of control over cancer — typically satisfied by more surveillance and treatment.

During the 1930s and ’40s, more and more cancer was being diagnosed. The rising numbers led to even greater pressure to define early stages of cancer and find more cases as early as possible. Meanwhile, the apparent improved cancer survival rates — a result of more people receiving diagnoses, many for cancers that were not lethal — seemed to prove the effectiveness of the “do not delay” campaign, as well as radical cancer surgery.

By the 1950s, some skeptics were pointing out that despite all the apparent progress, mortality rates for breast cancer had hardly budged. And they continued not to budge; from 1950 to 1990, there were about 28 breast cancer deaths per 100,000 people. But calls for earlier diagnosis only increased, especially after screening mammography was introduced in the 1960s.

When the 1971 evidence came along that mammograms were of very limited benefit to women under 50, it ran up against the logic of the early-detection model and the entrenched cycles of fear and control. Detecting cancer in women under 50 should work, according to the model; indeed, younger women are the ones most likely to have the localized cancers that have “not yet” metastasized. And many doctors and women understandably objected, as they do today, to giving up the one means they had to exercise some control over cancer.

Critics of this week’s recommendations have poked holes in the Preventive Services Task Force’s data analysis, have warned against basing present practice guidelines on the older imaging technology used in the studies, and have called for still more studies to be done. They generally sidestep the question of whether the very small numbers of lives potentially saved by screening younger women outweigh the health, psychological and financial costs of overdiagnosis.

You need to screen 1,900 women in their 40s for 10 years in order to prevent one death from breast cancer, and in the process you will have generated more than 1,000 false-positive screens and all the overtreatment they entail. This doesn’t make sense. We could do more research and hold more consensus conferences. I suspect it would confirm the data we already have. But history suggests it would never be enough to convince many people that we are screening too much.

Robert Aronowitz, an internist and a professor of the history and sociology of science at the University of Pennsylvania, is the author of “Unnatural History: Breast Cancer and American Society.”

http://www.nytimes.com/2009/11/20/opini ... nted=print
kmaherali
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Post by kmaherali »

November 27, 2009
Op-Ed Contributor
What’s Your Underlying Condition?
By JEROME GROOPMAN and PAMELA HARTZBAND
Boston

ONE of the profound mysteries of medicine is why in the midst of an epidemic some people become severely ill and die while others remain unscathed.

During the great plagues of past centuries, like the Black Death, smallpox and yellow fever, the answer was often cast in religious terms: survival was a miracle and succumbing was a punishment. During this influenza pandemic of H1N1, doctors and health officials invoke “underlying conditions.” This phrase, now so ubiquitous in news reports, is rightly understood to mean concurrent medical problems like diabetes and lung disease. But such underlying conditions are only part of the mystery of why this flu is so mild for some and so serious for others.

When faced with a new infectious outbreak, clinicians treat the sick while epidemiologists collect data on their characteristics: their age, gender, ethnic background, medical history, current medications and social factors like where they traveled and whom they contacted. Early in the H1N1 epidemic, health experts had an advantage in identifying risk factors for severe disease because past cases of seasonal influenza proved, in part, to be prologue. Familiar predisposing conditions like chronic lung disease, diabetes, heart trouble, immunosuppressive disorders and pregnancy were present in many early deaths.

With that knowledge, health officials tried to help the public find the midpoint between complacency and panic. But they were somewhat hamstrung in providing details about individual deaths in order to protect the confidentiality of patients and families; so in many instances, officials resorted to using that general phrase underlying conditions as an explanation. The result was that people who had such conditions appropriately felt increased concern while those without them felt a greater level of comfort.

But over the past weeks, the first scientific papers have been published in prominent medical journals detailing the demographics and medical histories of hundreds of patients who required hospitalization and, in many instances, died. These reports came not only from the United States but also Mexico, Canada, Australia and New Zealand, and expanded on the initial data released by the Centers for Disease Control and the World Health Organization over the summer.

According to these reports, many of the patients who became very ill with H1N1 did, in fact, have the same underlying conditions as those who often develop severe seasonal flu. But these reports pointed to some important differences between the viruses.

First, the early impression of many clinicians was confirmed: seasonal flu is typically harder on the elderly; H1N1 severely hits children and young adults. What’s more, the W.H.O. suggests that H1N1 may be more contagious than seasonal flu, infecting as many as 22 percent to 33 percent of contacts as opposed to 5 percent to 15 percent for seasonal flu.

Epidemiologists also found unexpected correlations between severe H1N1 flu and problems like obesity, hypertension and increased blood lipids. In Australia and New Zealand, aboriginal and Maori peoples were disproportionately stricken — as were Native American and Inuit populations in Canada. These associations had not been prominent in past flu outbreaks.

We also learned that in the United States, more than 25 percent of all those hospitalized seem to have had no major underlying conditions. According to a C.D.C. report in September, 12 of the 36 American children who died of H1N1 by early August appear to have been completely healthy before contracting the flu.

How, then, can we explain the striking differences in outcome after exposure of apparently healthy people to the H1N1 virus, ranging from no infection to a mild respiratory illness to death?

Insight may be gained from another recent and deadly outbreak, the H.I.V. epidemic. We learned important lessons from AIDS by moving from bedside observation to laboratory investigation, as epidemiologists and clinicians worked closely with basic scientists. As the virus spread, individuals were identified who did not become infected despite significant exposure to H.I.V. Even more curious were so-called elite controllers, those who became infected but remained healthy for decades with no evidence of decline in immunity.

H.I.V., like many other viruses, has proteins and sugars on its surface that allow it to attach to human cells at specific docking sites called receptors. Harnessing the power of modern molecular biology, researchers found that some people who were amply exposed to H.I.V. yet did not become infected had a genetic difference in their receptors that prevented the virus from effectively attaching and entering their cells.

This discovery led to a new drug to treat those with AIDS who did not have this genetic advantage, protecting yet uninfected cells from the virus. And those who have carried H.I.V. for years with no apparent effects are still being intensively studied by scientists; these elite controllers may have cadres of certain immune cells that restrain the deadly pathogen. Unraveling the mysteries of the unscathed could lead to still more novel therapies.

A similar strategy of studying the genetics, receptors and immune response of people who appear to resist infection versus those who rapidly succumb is being applied to other deadly pathogens like hepatitis C, and is clearly applicable to influenza as well. There are, in fact, initial findings from researchers in Europe and Japan showing that the new virus can attach not only to receptors that bind seasonal flu, but also to other receptors deep in the lungs. Genetic differences in these other receptors could account for severe respiratory illness in some H1N1 cases.

In an epidemic, each one of us wants to know our personal risk for illness. The current definition of underlying conditions communicates only a level of increased risk, not individual susceptibility. For the first time in history, though, scientists are poised to redefine underlying conditions in a more profound way based on individual immune response. Deep in our genes, there may very well be another underlying condition that determines in part whether a virus will cause us mild or no disease, or severe illness and death.

Jerome Groopman, a staff writer for The New Yorker, and Pamela Hartzband are attending physicians at Beth Israel Deaconess Medical Center and professors at Harvard Medical School.

http://www.nytimes.com/2009/11/27/opini ... nted=print

******
Brain Power

For all that scientists have studied it, the brain remains the most complex and mysterious human organ - and, now, the focus of billions of dollars' worth of research to penetrate its secrets. The Brain Power series looks in depth at some of the insights these projects are producing.

http://topics.nytimes.com/top/news/scie ... index.html
Articles in the Series
Newest First | Oldest First
Page: 1
Surgery for Mental Ills Offers Both Hope and Risk
By BENEDICT CAREY
Hundreds have undergone brain surgery for problems like depression, anxiety, even obesity.

November 27, 2009After Injury, Fighting to Regain a Sense of Self
By BENEDICT CAREY
Scientists are investigating delusions caused by brain trauma for clues to one of the most confounding problems in brain science: identity.

August 9, 2009In Battle, Hunches Prove to Be Valuable
By BENEDICT CAREY
U.S. soldiers are at the center of an effort to understand how it is that some people’s brains can sense danger before others’ do.

July 28, 2009At the Bridge Table, Clues to a Lucid Old Age
By BENEDICT CAREY
A study of people 90 and over without a trace of dementia has begun to alter understandings of the aging brain.

May 22, 2009Brain Researchers Open Door to Editing Memory
By BENEDICT CAREY
An influx of money and talent into neuroscience has led to an experimental drug that could block certain memories.

April 6, 2009H. M., an Unforgettable Amnesiac, Dies at 82
By BENEDICT CAREY
Henry Gustav Molaison, or H.M., was recognized as the most important patient in the history of brain science.

December 5, 2008
kmaherali
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Post by kmaherali »

Humans are never vegetables

Calgary Herald
November 28, 2009 8:44 AM
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If Rom Houben's case proves anything, it is the arrogance of those who think they can pronounce upon the state of a patient's consciousness, and determine his subsequent fate--when humility should force them to admit they cannot possibly know what that patient may be experiencing.
Houben is the Belgian man who spent 23 years misdiagnosed as being in a persistent vegetative state when he was actually conscious and suffering from locked-in syndrome as the result of an auto accident. Locked-in syndrome means the individual is paralyzed, but retains full consciousness.

The misdiagnosis was discovered thanks to state-of-the-art brain scanning technology which neurologist Steven Laureys at Liege University Hospital used to discover that Houben still had activity in his cerebral cortex.

One has to wonder how many other patients through the years have been wrongly diagnosed as being in a coma or cruelly labelled "vegetables"-- a term which should be banished from the language as a reference point for discussing human beings.

Terri Schiavo's case comes to mind. Doctors argued for years over the level of consciousness they thought the Florida woman was capable of -- and their conclusions varied, whether they sided with Schiavo's husband, Michael, who wanted her feeding tube pulled so she would die or whether they sided with Schiavo's parents, who insisted she was conscious, recognized them and expressed emotions, including joy. Schiavo had suffered brain damage in 1990 after cardiac arrest, and she died in 2005, almost two weeks after her feeding tube was removed -- forcing her to undergo a slow death by starvation and dehydration.

Bobby Schindler, Schiavo's brother and executive director of the Terri Schindler Schiavo Foundation, commenting on Houben's case, told ABCNews.com:"We are learning how unscientific the diagnosis is. It's completely subjective and we are using it to sentence people to death, and it's dangerous."

It is indeed dangerous. Had that gross misnomer "the right to die" been at issue in Houben's case, this fully conscious man would have had to undergo the agony of people debating whether he should be allowed to live, and he could have faced the agony of knowing he was being starved to death, unable to communicate with anyone to let them know there was indeed a fully aware person inside his paralyzed body. Particularly poignant was Houben's description, via a special keyboard and computer, of how he tried to alert his caregivers to his conscious state: "I screamed, but there was nothing to hear."

He characterized the day the misdiagnosis was revealed as a rebirth for him: "I especially felt relief. Finally to be able to show that I was indeed there."

The lesson from Houben's case--and reinforced, sadly, too late by Schiavo's case-- is that if doctors and courts must err, it should always be on the side of life, and on the assumption that despite all outward appearances, the "I" is "indeed there."
© Copyright (c) The Calgary Herald

http://www.calgaryherald.com/health/Hum ... story.html
kmaherali
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December 6, 2009
Op-Ed Columnist
Cancer From the Kitchen?
By NICHOLAS D. KRISTOF

The battle over health care focuses on access to insurance, or tempests like the one that erupted over new mammogram guidelines.

But what about broader public health challenges? What if breast cancer in the United States has less to do with insurance or mammograms and more to do with contaminants in our water or air -- or in certain plastic containers in our kitchens? What if the surge in asthma and childhood leukemia reflect, in part, the poisons we impose upon ourselves?

This last week I attended a fascinating symposium at Mount Sinai School of Medicine in New York, exploring whether certain common chemicals are linked to breast cancer and other ailments.

Dr. Philip Landrigan, the chairman of the department of preventive medicine at Mount Sinai, said that the risk that a 50-year-old white woman will develop breast cancer has soared to 12 percent today, from 1 percent in 1975. (Some of that is probably a result of better detection.) Younger people also seem to be developing breast cancer: This year a 10-year-old in California, Hannah, is fighting breast cancer and recording her struggle on a blog.

Likewise, asthma rates have tripled over the last 25 years, Dr. Landrigan said. Childhood leukemia is increasing by 1 percent per year. Obesity has surged. One factor may be lifestyle changes — like less physical exercise and more stress and fast food — but some chemicals may also play a role.

Take breast cancer. One puzzle has been that most women living in Asia have low rates of breast cancer, but ethnic Asian women born and raised in the United States don’t enjoy that benefit. At the symposium, Dr. Alisan Goldfarb, a surgeon specializing in breast cancer, pointed to a chart showing breast cancer rates by ethnicity.

“If an Asian woman moves to New York, her daughters will be in this column,” she said, pointing to “whites.” “It is something to do with the environment.”

What’s happening? One theory starts with the well-known fact that women with more lifetime menstrual cycles are at greater risk for breast cancer, because they’re exposed to more estrogen. For example, a woman who began menstruating before 12 has a 30 percent greater risk of breast cancer than one who began at 15 or later.

It’s also well established that Western women are beginning puberty earlier, and going through menopause later. Dr. Maida Galvez, a pediatrician who runs Mount Sinai’s pediatric environmental health specialty unit, told the symposium that American girls in the year 1800 had their first period, on average, at about age 17. By 1900 that had dropped to 14. Now it is 12.

A number of studies, mostly in animals, have linked early puberty to exposure to pesticides, P.C.B.’s and other chemicals. One class of chemicals that creates concern — although the evidence is not definitive — is endocrine disruptors, which are often similar to estrogen and may fool the body into setting off hormonal changes. This used to be a fringe theory, but it is now being treated with great seriousness by the Endocrine Society, the professional association of hormone specialists in the United States.

These endocrine disruptors are found in everything from certain plastics to various cosmetics. “There’s a ton of stuff around that has estrogenic material in it,” Dr. Goldfarb said. “There’s makeup that you rub into your skin for a youthful appearance that is really estrogen.”

More than 80,000 new chemicals have been developed since World War II, according to the Children’s Environmental Health Center at Mount Sinai. Even of the major chemicals, fewer than 20 percent have been tested for toxicity to children, the center says.

Representative Louise Slaughter, the only microbiologist in the House of Representatives, introduced legislation this month that would establish a comprehensive program to monitor endocrine disruptors. That’s an excellent idea, because as long as we’re examining our medical system, there’s a remarkable precedent for a public health effort against a toxic substance. The removal of lead from gasoline resulted in an 80 percent decline in lead levels in our blood since 1976 — along with a six-point gain in children’s I.Q.’s, Dr. Landrigan said.

I asked these doctors what they do in their own homes to reduce risks. They said that they avoid microwaving food in plastic or putting plastics in the dishwasher, because heat may cause chemicals to leach out. And the symposium handed out a reminder card listing “safer plastics” as those marked (usually at the bottom of a container) 1, 2, 4 or 5.

It suggests that the “plastics to avoid” are those numbered 3, 6 and 7 (unless they are also marked “BPA-free”). Yes, the evidence is uncertain, but my weekend project is to go through containers in our house and toss out 3’s, 6’s and 7’s.

I invite you to comment on this column on my blog, On the Ground. Please also join me on Facebook, watch my YouTube videos and follow me on Twitter.
http://www.nytimes.com/2009/12/06/opini ... nted=print
kmaherali
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CT scans add to cancer deaths, say researchers

Reuters
December 15, 2009

R adiation from CT scans done in 2007 will cause 29,000 cancers and kill nearly 15,000 Americans, researchers said on Monday.

The findings, published in the Archives of Internal Medicine, add to mounting evidence that Americans are overexposed to radiation from diagnostic tests, especially from a specialized kind of X-ray called a computed tomography, or CT, scan.

"What we learned is there is a significant amount of radiation with these CT scans, more than what we thought, and there is a significant number of cancers," said Dr. Rita Redberg, editor of the Archives of Internal Medicine, where the studies were published.

"It's estimated that just from the CT scans done in one year, just in 2007, there will be 15,000 excess deaths," Redberg said in a telephone interview. "We're doing millions of CT scans every year and the numbers are increasing. That is a lot of excess deaths."

CT scans give doctors a view inside the body, often eliminating the need for exploratory surgery. But CT scans involve much higher radiation doses than conventional X-rays.

About 70 million CT scans were done on Americans in 2007, up from three million in 1980. Amy Berrington de Gonzalez of the National Cancer Institute and colleagues developed a computer model to estimate the impact of so many scans.

They estimated the scans done in 2007 will cause 29,000 cancers.

"While certainly some of the scans are incredibly important and life saving, it is also certain that some of them were not necessary," Redberg said.

© Copyright (c) The Calgary Herald
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kmaherali
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February 25, 2010
Op-Ed Columnist
Do Toxins Cause Autism?
By NICHOLAS D. KRISTOF

Autism was first identified in 1943 in an obscure medical journal. Since then it has become a frighteningly common affliction, with the Centers for Disease Control reporting recently that autism disorders now affect almost 1 percent of children.

Over recent decades, other development disorders also appear to have proliferated, along with certain cancers in children and adults. Why? No one knows for certain. And despite their financial and human cost, they presumably won’t be discussed much at Thursday’s White House summit on health care.

Yet they constitute a huge national health burden, and suspicions are growing that one culprit may be chemicals in the environment. An article in a forthcoming issue of a peer-reviewed medical journal, Current Opinion in Pediatrics, just posted online, makes this explicit.

The article cites “historically important, proof-of-concept studies that specifically link autism to environmental exposures experienced prenatally.” It adds that the “likelihood is high” that many chemicals “have potential to cause injury to the developing brain and to produce neurodevelopmental disorders.”

The author is not a granola-munching crank but Dr. Philip J. Landrigan, professor of pediatrics at the Mount Sinai School of Medicine in New York and chairman of the school’s department of preventive medicine. While his article is full of cautionary language, Dr. Landrigan told me that he is increasingly confident that autism and other ailments are, in part, the result of the impact of environmental chemicals on the brain as it is being formed.

“The crux of this is brain development,” he said. “If babies are exposed in the womb or shortly after birth to chemicals that interfere with brain development, the consequences last a lifetime.”

Concern about toxins in the environment used to be a fringe view. But alarm has moved into the medical mainstream. Toxicologists, endocrinologists and oncologists seem to be the most concerned.

One uncertainty is to what extent the reported increases in autism simply reflect a more common diagnosis of what might previously have been called mental retardation. There are genetic components to autism (identical twins are more likely to share autism than fraternal twins), but genetics explains only about one-quarter of autism cases.

Suspicions of toxins arise partly because studies have found that disproportionate shares of children develop autism after they are exposed in the womb to medications such as thalidomide (a sedative), misoprostol (ulcer medicine) and valproic acid (anticonvulsant). Of children born to women who took valproic acid early in pregnancy, 11 percent were autistic. In each case, fetuses seem most vulnerable to these drugs in the first trimester of pregnancy, sometimes just a few weeks after conception.

So as we try to improve our health care, it’s also prudent to curb the risks from the chemicals that envelop us. Senator Frank Lautenberg of New Jersey is drafting much-needed legislation that would strengthen the Toxic Substances Control Act. It is moving ahead despite his own recent cancer diagnosis, and it can be considered as an element of health reform. Senator Lautenberg says that under existing law, of 80,000 chemicals registered in the U.S., the Environmental Protection Agency has required safety testing of only 200. “Our children have become test subjects,” he noted.

One peer-reviewed study published this year in Environmental Health Perspectives gave a hint of the risks. Researchers measured the levels of suspect chemicals called phthalates in the urine of pregnant women. Among women with higher levels of certain phthalates (those commonly found in fragrances, shampoos, cosmetics and nail polishes), their children years later were more likely to display disruptive behavior.

Frankly, these are difficult issues for journalists to write about. Evidence is technical, fragmentary and conflicting, and there’s a danger of sensationalizing risks. Publicity about fears that vaccinations cause autism — a theory that has now been discredited — perhaps had the catastrophic consequence of lowering vaccination rates in America.

On the other hand, in the case of great health dangers of modern times — mercury, lead, tobacco, asbestos — journalists were too slow to blow the whistle. In public health, we in the press have more often been lap dogs than watchdogs.

At a time when many Americans still use plastic containers to microwave food, in ways that make toxicologists blanch, we need accelerated research, regulation and consumer protection.

“There are diseases that are increasing in the population that we have no known cause for,” said Alan M. Goldberg, a professor of toxicology at the Bloomberg School of Public Health at Johns Hopkins University. “Breast cancer, prostate cancer, autism are three examples. The potential is for these diseases to be on the rise because of chemicals in the environment.”

The precautionary principle suggests that we should be wary of personal products like fragrances unless they are marked phthalate-free. And it makes sense — particularly for children and pregnant women — to avoid most plastics marked at the bottom as 3, 6 and 7 because they are the ones associated with potentially harmful toxins.



I invite you to visit my blog, On the Ground. Please also join me on Facebook, watch my YouTube videos and follow me on Twitter.

Gail Collins is off today.

http://www.nytimes.com/2010/02/25/opini ... nted=print
Biryani
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WHAT ABOUT REAL HEALTH INSURANCE?

Post by Biryani »

There is little talk of something that could drastically reduce healthcare prices in U.S. : Health.

Current numbers vary from 23.6 million to 24 million of U.S. citizens with diabetes, depending on which study you read. From 2007 to 2009, the number has increased by 15%. Most studies predict that in 10 years, about 50 million Americans will have diabetes. If this is not an epidemic, I don’t know what is.

Just 90 miles south of the U.S., there is a country that is combating diabetes: Cuba. About 10 years ago, the government began an education program. From the first grade up, Cuban kids learn of diabetes in school and how to prevent the disease.

The Cubans went even further than education: the government began an organic farming program. Farmers were paid to raise and sell crops to the government, which, in turn, sold them cheaply to the public. If a farmer had a surplus after selling his goods to the government, he was allowed to sell those privately.

Today, there are more than 7,000 plots occupying more than 81,000 acres on which organic food is farmed in Cuba. Many of these are located in urban areas as well as rural venues. In Havana, there are more than 200 gardens, some in small spaces between tower block estates that supply the city’s population with more than 90% of their fruit and vegetables. The farmers are obligated to farm a certain amount of products for the Cuban government. The surplus then belongs to the farmers who sell it for profit, which is divided among them.

After the Soviet Union dropped Cuba like a hot potato, the island country found itself without finances. At that time, Cuba imported much of its food, so it had to change its methods to feed its citizens. The Independent daily newspaper of Great Britain ran a story on August 8, 2006, titled, "The Good Life in Havana: Cuba’s Green Revolution." According to the article:

“...Twenty years ago, following the collapse of the Soviet Union, Fidel Castro’s small island faced a food crisis. Today, its networks of small urban farmers are thriving, an organic success story that is feeding the nation…”

Laura Enriquez, a sociologist at the University of California, Berkeley, who has written extensively on the subject of Latin American agriculture, said, "What happened in Cuba was remarkable. It was remarkable that they decided to prioritize food production. Other countries in the region took the neo-liberal option and exported ‘what they were good at’ and imported food. The Cubans went for food security and part of that was prioritizing small farmers."

Currently, the population of Cuba suffers diabetes at about 10% the rate of U.S. citizens who have the disease. Maybe the malady will be eradicated in Cuba someday.

In addition to diabetes, obesity creates deadly problems with one’s heart, lungs, liver and kidneys. Various estimates put the number of U.S. citizens who are obese at 50-65%. But, there is no national program to dissuade people from over-eating or eating processed foods that create fatal diseases.

A small portion of the U.S. public is aware of the hazards of processed food and attempt to eat organic items. Unfortunately, they are not widely available. Many towns may offer a "Farmer’s Market" for a few hours on one day a week in which farmers can sell their goods. Unlike Cuba, however, the prices of organic food in the U.S. are much higher than those of processed items. In other words, it is a luxury to try to eat healthy food.

The cost of healthcare in the U.S. far exceeds the cost of a preventive educational program about health for the U.S. public. Imagine if the U.S. called off the war in Iraq for one week. The savings in money would allow the government to produce and supply the public with healthy organic food. But, there are two problems with such a plan: 1. Nobody would make a profit, therefore making the plan un-American. 2. Instead of killing people, the money could be spent on helping people live, again another un-American concept.

I have always maintained that those nations who oppose U.S. hegemony are wrong in their approach to bring justice to the world. Instead of speaking up against the imperialist actions of the U.S., they should keep quiet and out of the radar. Within a few decades, the U.S. public just might eat itself to death.

Source: http://www.malcomlagauche.com/
kmaherali
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Post by kmaherali »

March 21, 2010
Op-Ed Columnist
Is Any Illness Covered?
By NICHOLAS D. KRISTOF

Health care is etched on my mind these days not only because of the Capitol Cacophony but also because a husband and wife I know, my former neighbors, are undergoing the kind of heartbreak no family should endure.

Zack Liu and Jan Li, along with their two young daughters, lived a few doors away from me. Then a couple of years ago they moved to Hong Kong, and paid $4,500 per year for a health insurance policy for Jan and the girls (Zack was covered through his job).

Last April 24, their world collapsed: Jan was diagnosed with late-stage stomach cancer.

Opponents of the reform proposals argue: If you like the Department of Motor Vehicles, you’ll love Obamacare. But as the drama of Zack and Jan shows, the only bureaucrats more obdurate than those at the D.M.V. are the ones working for insurance companies. The existing system is preposterous: we rely on insurance companies whose business model is based on accepting premiums from healthy people and devising ways to exclude from coverage those who most desperately need medical care.

Jan’s stomach was removed, and she underwent extensive chemotherapy. Then in October, her doctors discovered that the cancer had spread to her intestines. She has been hospitalized ever since.

The insurance company is InterGlobal, based in London, and the policy ostensibly covered up to $1.7 million in costs. But, according to Zack, the company said the policy allowed it to cut Jan off because she suffered from a “chronic condition.” It stopped paying her bills in January, Zack says.

I reached Sophie Walker, the group head of claims for InterGlobal. She said she couldn’t talk about an individual case. But she explained in an e-mail message that with a “chronic condition” the policies can have a much lower limit, $85,000, on lifetime claims. That’s the limit that Jan ran into in January, Zack says.

Then Ms. Walker gave me the company’s definition of “chronic” (you couldn’t make this up):

“Chronic means a medical condition which has at least one of the following characteristics: has no known cure; is likely to recur; requires palliative treatment; needs prolonged monitoring/ treatment; is permanent; requires specialist training/rehabilitation; is caused by changes to the body that cannot be reversed.”

That sounds like a spoof from “The Daily Show.” To translate: We’ll pay for care unless you get sick with just about anything that might be expensive. Then we’ll cut you off at the knees.

I asked InterGlobal if this was an accurate translation. I noted that by its definition, cancer, heart disease, strokes, diabetes, tennis elbow and even athlete’s foot seemed to be “chronic.” I also asked InterGlobal to name any serious disease that it did not consider “chronic.”

The next e-mail message came back from the company’s chief executive, Stephen Hartigan, who sent his “kind regards” but added that because he was “disappointed” at the tone of my inquiries, the company would have no further comment.

Zack and Jan are a special case in the health care arena: although they and their daughters are all American citizens, they’re living abroad and struggling with an overseas-based insurance company. But their plight underscores the fundamental weakness of any system that leaves us dependent on the magnanimity of for-profit insurance companies.

Those opposing reform argue that emergency rooms are always available as a backstop for those without insurance. That rings hollow for a woman with, say, stomach cancer. More broadly, E.R.’s simply cannot solve the larger health needs of the roughly 75 million Americans who are either uninsured or underinsured.

The conundrum is this: It’s in the interest of insurance companies to exclude people who are sick, while it’s in our national interest to see them covered. Plus, it’s the right thing to do.

As the Institute of Medicine, a branch of the National Academy of Sciences, declared in a landmark report last year, “The absence of health insurance is hazardous to your health.” Among the many studies that demonstrate that is one conducted in Kentucky that found cancers are detected later in women who have no insurance than in women who do — so those without are 44 percent more likely to die of breast cancer.

Another study found that for American adults ages 55 to 64, lack of insurance is “third on a list of leading causes of death for this age group, behind only heart disease and cancer.” All told, depending on who does the math, 20,000 to 45,000 Americans die each year for lack of health insurance.

So that’s what’s at stake. Far too many Americans must wrestle simultaneously with mortality and insurance companies, as Zack and Jan are. That must end.

I invite you to comment on this column on my blog, On the Ground. Please also join me on Facebook, watch my YouTube videos and follow me on Twitter.

http://www.nytimes.com/2010/03/21/opini ... nted=print
kmaherali
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Post by kmaherali »

Maternal health includes contraception
Calgary Herald
March 28, 2010

The Harper government should include contraception among its maternal and child health measures at this June's G8 summit in Huntsville, Ont. Leaving it out would be tantamount to ignoring the serious challenge from population growth which the developing world faces. A focus on contraception does not mean returning to last week's divisive and failed Liberal motion to get abortion included in the plans, but it does require the government to sensitively promote the subject of smaller families to Third World nations through a variety of family planning efforts.

According to the United Nations, 99 per cent of world population growth to 2050 will be in the developing world, the area least equipped to deal with the strains such an expansion will put on infrastructure, basic services and resources.

Reducing family size brings enormous benefits. Child mortality falls by 13 per cent if women wait two years between pregnancies and plunges by a quarter if pregnancies are spaced at least three years apart, while maternal deaths could be reduced by 27 per cent without unplanned pregnancies.

Parents with fewer children have more time, energy and resources to devote to their offspring and place less of a burden on health services.

Third World parents are not unwilling to be educated about family planning. A study reported through the Geneva Foundation on Medical Education and Research found that "in Cameroon ... 64 per cent of men in the rural areas of Akonolinga and 63 per cent in the rural areas of Obala are favourable to contraceptive practice, while another study among university students in Yaounde showed a favourable attitude in 92 per cent of unmarried couples and 98 per cent of married couples."

The study found that impediments to contraceptive practice include religious beliefs, lack of information, lack of education, high infant mortality, service delivery constraints, reluctance to talk about sexuality, and lack of political will.

However, government attitudes are shifting; the study noted that the government of Cameroon's attitude has gone "from open hostility toward family planning to tolerance under responsible parenthood and to commitment to family planning as a national policy. Most African countries have followed the same pattern of evolution as Cameroon."

Another study out of Johns Hopkins University in Baltimore, which examined attitudes toward contraception in Ilorin, Nigeria, found that 80 per cent of women who were educated about contraception thought it the best method of family planning.

Contraceptive knowledge is essential to maternal health. The Canadian government would not shy away from providing Canadian women with information that would improve their health; it should do no less for the women of the Third World.

© Copyright (c) The Calgary Herald

http://www.calgaryherald.com/story_prin ... 1&sponsor=
kmaherali
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Post by kmaherali »

Mammograms catch few cancers in young women: study
WASHINGTON


WASHINGTON (Reuters) - Mammograms detect few cancers in women under the age of 40 but cause expense and anxiety because women frequently get "false positives" that require follow-up to rule out cancer, researchers reported on Monday.

Health

Mammograms did not detect any tumors among women under the age of 25, the researchers reported in the Journal of the National Cancer Institute.

The study of more than 117,000 U.S. women may reinforce controversial recommendations about the use of mammograms to screen for breast cancer among younger women.

Radiologist Bonnie Yankaskas of the University of North Carolina at Chapel Hill and colleagues examined the records of women aged 18 to 39 when they got their first mammograms starting in 1995, following them for a year to see what happened.

There were no tumors among the women under 25. For women aged 35 to 39, 12.7 per 1,000 got called back for further checks after the mammogram produced a suspicious-looking lesion. Very few actually had a tumor.

"In a theoretical population of 10,000 women aged 35 to 39 years, 1,266 women who are screened will receive further workup, with 16 cancers detected and 1,250 women receiving a false-positive result," Yankaskas and colleagues wrote.

"Harms need to be considered, including radiation exposure because such exposure is more harmful in young women, the anxiety associated with false-positive findings on the initial examination, and costs associated with additional imaging," they added.

About 29 percent of U.S. women aged 30 to 40 say they have had a mammogram.

Dr. Ned Calonge of the Colorado Department of Public Health and Environment said the findings suggest that women under 40 should not get mammograms unless they have symptoms of breast cancer, such as a lump.

Last November the U.S. Preventive Services Task Force, a federal scientific advisory panel, said women in their 40s with an average risk for breast cancer did not need annual mammograms to screen for the disease.

The guidelines touched off a debate among cancer doctors.

Calonge noted that most groups agree that women under 40 probably do not need mammograms to screen for cancer and Monday's study supports this approach.

Breast cancer is the most common cancer in women worldwide, accounting for around 16 percent of all female cancers. It kills around 465,000 people globally each year.

(Reporting by Maggie Fox; Editing by Cynthia Osterman)

http://www.reuters.com/article/idUSTRE6424VY20100504
kmaherali
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Post by kmaherali »

June 5, 2010
Growing Obesity Increases Perils of Childbearing
By ANEMONA HARTOCOLLIS

As Americans have grown fatter over the last generation, inviting more heart disease, diabetes and premature deaths, all that extra weight has also become a burden in the maternity ward, where babies take their first breath of life.

About one in five women are obese when they become pregnant, meaning they have a body mass index of at least 30, as would a 5-foot-5 woman weighing 180 pounds, according to researchers with the federal Centers for Disease Control and Prevention. And medical evidence suggests that obesity might be contributing to record-high rates of Caesarean sections and leading to more birth defects and deaths for mothers and babies.

Hospitals, especially in poor neighborhoods, have been forced to adjust. They are buying longer surgical instruments, more sophisticated fetal testing machines and bigger beds. They are holding sensitivity training for staff members and counseling women about losing weight, or even having bariatric surgery, before they become pregnant.

At Maimonides Medical Center in Brooklyn, where 38 percent of women giving birth are obese, Patricia Garcia had to be admitted after she had a stroke, part of a constellation of illnesses related to her weight, including diabetes and weak kidneys.

At seven months pregnant, she should have been feeling the thump of tiny feet against her belly. But as she lay flat in her hospital bed, doctors buzzing about, trying to stretch out her pregnancy day by precious day, Ms. Garcia, who had recently weighed in at 261 pounds, said she was too numb from water retention to feel anything.

On May 5, 11 weeks shy of her due date, a sonogram showed that the baby’s growth was lagging, and an emergency Caesarean was ordered.

She was given general anesthesia because her bulk made it hard to feel her spine to place a local anesthetic. Dr. Betsy Lantner, the obstetrician on call, stood on a stool so she could reach over Ms. Garcia’s belly. A flap of fat covered her bikini line, so the doctor had to make a higher incision. In an operation where every minute counted, it took four or five minutes, rather than the usual one or two, to pull out a 1-pound 11-ounce baby boy.

Studies have shown that babies born to obese women are nearly three times as likely to die within the first month of birth than women of normal weight, and that obese women are almost twice as likely to have a stillbirth.

About two out of three maternal deaths in New York State from 2003 to 2005 were associated with maternal obesity, according to the state-sponsored Safe Motherhood Initiative, which is analyzing more recent data.

Obese women are also more likely to have high blood pressure, diabetes, anesthesia complications, hemorrhage, blood clots and strokes during pregnancy and childbirth, data shows.

The problem has become so acute that five New York City hospitals — Beth Israel Medical Center and Mount Sinai Medical Center in Manhattan, Maimonides in Brooklyn and Montefiore Medical Center and Bronx-Lebanon Hospital Center in the Bronx — have formed a consortium to figure out how to handle it. They are supported by their malpractice insurer and the United Hospital Fund, a research group.

One possibility is to create specialized centers for obese women. The centers would counsel them on nutrition and weight loss, and would be staffed to provide emergency Caesarean sections and intensive care for newborns, said Dr. Adam P. Buckley, an obstetrician and patient safety expert at Beth Israel Hospital North who is leading the group.

Very obese women, or those with a B.M.I. of 35 or higher, are three to four times as likely to deliver their first baby by Caesarean section as first-time mothers of normal weight, according to a study by the Consortium on Safe Labor of the National Institutes of Health.

While doctors are often on the defensive about whether Caesarean sections, which carry all the risks of surgery, are justified, Dr. Howard L. Minkoff, the chairman of obstetrics at Maimonides, said doctors must weigh those concerns against the potential complications from vaginal delivery in obese women. Typically, these include failing to progress in labor; diabetes in the mother, which can lead to birth complications; and difficulty monitoring fetal distress. “With obese women we are stuck between Scylla and Charybdis,” Dr. Minkoff said.

But even routine care, like finding a vein to take blood, can be harder through layers of fatty tissue.

And equipment can be a problem. Dr. Janice Henderson, an obstetrician for high-risk pregnancies at Johns Hopkins in Baltimore, described a recent meeting where doctors worried that the delivery room table might collapse under the weight of an obese patient.

At Maimonides, the perinatal unit threw away its old examining tables and replaced them with wider, sturdier ones. It bought ultrasound machines that make lifelike three-dimensional images early in pregnancy, when the fetus is still low in the uterus and less obscured by fat, but also less developed and thus harder to diagnose clearly. “You really need to use the best equipment, which is more expensive,” said Dr. Shoshana Haberman, the director of perinatal services.

Many experienced obstetricians complain that as Americans have grown larger, the perception of what constitutes obesity has shifted, leading to some complacency among doctors. At UMass Memorial Medical Center in Worcester, Mass., Dr. Tiffany A. Moore Simas, the associate director of the residency program in obstetrics, demands that residents calculate B.M.I. as a routine part of prenatal treatment. “It’s one of my siren songs,” Dr. Moore Simas said, “because we are very bad at eyeballing people.”

Dr. Haberman said there was obesity in her own family, and she had seen how hurtful even professionals could be. “We as a society have issues with the perception of obesity; anatomically, you get turned off,” she said.

So she was sympathetic to Ms. Garcia, making sure she got a room with a window, and calling to check on her after hours.

Ms. Garcia, 38, a former school bus dispatcher, is 5 feet tall. She said she had tried diets, weight-watching groups and joining a gym. She was 195 pounds before her pregnancy (B.M.I., 38) and ballooned to 261 pounds, which she attributed to water weight and inactivity.

“I’m the smallest one in my family,” she said. Her older brother weighed more than 700 pounds before having gastric bypass surgery.

She wiped tears away as she confessed that she worried that she might die and leave her baby without a mother.

At Ms. Garcia’s stage of pregnancy, every day in the womb was good for the baby but bad for the mother, Dr. Minkoff said. “She’s making a heroic decision to put her own self in peril for the sake of the child,” he said.

She survived, but was dismayed by the size of her son, Josiah Patrick, who had to be put on a breathing machine. At first she could see him only by remote video. But after a month, Josiah was off the ventilator, taking 15 milliliters of formula and had smiled at his mother, and doctors said he was where he should be developmentally for a preemie his age.

The hospital estimated that the cost of caring for the mother and baby would be more than $200,000, compared with $13,000 for a normal delivery.

Ms. Garcia promised Dr. Minkoff that she would lose weight and see her baby graduate from college. “I’m going on a strict, strict, strict diet,” she said. “I’m not going through this again.”

http://www.nytimes.com/2010/06/06/healt ... nted=print
kmaherali
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Post by kmaherali »

July 13, 2010
Rules Seek to Expand Diagnosis of Alzheimer’s
By GINA KOLATA

For the first time in 25 years, medical experts are proposing a major change in the criteria for Alzheimer’s disease, part of a new movement to diagnose and, eventually, treat the disease earlier.

The new diagnostic guidelines, presented Tuesday at an international Alzheimer’s meeting in Hawaii, would mean that new technology like brain scans would be used to detect the disease even before there are evident memory problems or other symptoms.

If the guidelines are adopted in the fall, as expected, some experts predict a two- to threefold increase in the number of people with Alzheimer’s disease. Many more people would be told they probably are on their way to getting it. The Alzheimer’s Association says 5.3 million Americans now have the disease.

The changes could also help drug companies that are, for the first time, developing new drugs to try to attack the disease earlier. So far, there are no drugs that alter the course of the disease.

Development of the guidelines, by panels of experts convened by the National Institute on Aging and the Alzheimer’s Association, began a year ago because, with a new understanding of the disease and new ways of detection, it was becoming clear that the old method of diagnosing Alzheimer’s was sorely outdated.

The current formal criteria for diagnosing Alzheimer’s require steadily progressing dementia — memory loss and an inability to carry out day-to-day activities, like dressing or bathing — along with a pathologist’s report of plaque and another abnormality, known as tangles, in the brain after death.

But researchers are now convinced that the disease is present a decade or more before dementia.

“Our thinking has changed dramatically,” said Dr. Paul Aisen, an Alzheimer’s researcher at the University of California, San Diego, and a member of one of the groups formulating the new guidelines. “We now view dementia as a late stage in the process.”

The new guidelines include criteria for three stages of the disease: preclinical disease, mild cognitive impairment due to Alzheimer’s disease and, lastly, Alzheimer’s dementia. The guidelines should make diagnosing the final stage of the disease in people who have dementia more definitive. But, the guidelines also say that the earlier a diagnosis is made the less certain it is. And so the new effort to diagnose the disease earlier could, at least initially, lead to more mistaken diagnoses.

Under the new guidelines, for the first time, diagnoses will aim to identify the disease as it is developing by using results from so-called biomarkers — tests like brain scans, M.R.I. scans and spinal taps that reveal telltale brain changes.

The biomarkers were developed and tested only recently and none have been formally approved for Alzheimer’s diagnosis. One of the newest, a PET scan, shows plaque in the brain — a unique sign of Alzheimer’s brain pathology. The others provide strong indications that Alzheimer’s is present, even when patients do not yet have dementia or even much memory loss.

Dr. Aisen says he foresees a day when people in their 50s routinely have biomarker tests for Alzheimer’s and, if the tests indicate the disease is brewing, take drugs to halt it. That is a ways off but, he said, but “it’s where we are heading.”

“This is a major advance,” said Dr. John Morris, an Alzheimer’s researcher at Washington University in St. Louis who helped formulate the guidelines. “We used to say we did not know for certain it was Alzheimer’s until the brain is examined on autopsy.”

Dr. Ronald Petersen, an Alzheimer’s researcher at the Mayo Clinic in Minnesota and chairman of the Alzheimer’s Association’s medical and scientific advisory council, said adding biomarkers to a diagnosis would be a big improvement.

Today, he says, when a patient comes with memory problems, doctors might say that the person has a chance of developing Alzheimer’s in the next decade, a chance of not getting much worse for several years, and a chance of actually getting better.

Tests like brain scans, Dr. Petersen said, “will allow us to be much more definitive.” If the tests show changes characteristic of Alzheimer’s disease, a doctor can say, “I think you are on the Alzheimer’s road.”

That can be a difficult conversation, but it can allow patients and their families to plan. “At least it’s a conversation the physician can have with the patient,” Dr. Petersen said.

Alzheimer’s experts welcomed the new criteria.

“Over all, I think this is a giant step in the right direction,” said Dr. P. Murali Doraiswamy, a psychiatry professor and Alzheimer’s disease researcher at Duke University who was not involved with making the guidelines. “It moves us closer to the cause of the disease rather than just looking at symptoms.”

But, he added, it also is a huge change.

“This has implications for everybody alive, anybody who is getting older,” Dr. Doraiswamy said. Among other things, he said, it will encourage a lot more testing. And, Dr. Doraiswamy said, “diagnosis rates, like testing rates, only go in one direction — up.”

Doctors will have to learn new terms — preclinical Alzheimer’s; prodromal, or early stage, Alzheimer’s. Patients going to see a doctor with memory problems might be offered biomarker tests, which can be expensive.

The ripple extends beyond doctors and patients, Dr. Doraiswamy said. The new diagnostic criteria also have consequences for lawyers, insurance companies and workers’ compensation programs.

And, he said, people have to be prepared for unintended consequences, which always occur when the diagnosis of a disease is changed. For now, he said: “We ought to be cautious that we don’t stimulate all this testing before we can give people something to manage their disease. There is no point in giving them just a label.”

http://www.nytimes.com/2010/07/14/healt ... &th&emc=th

*****
http://www.nytimes.com/2010/07/17/healt ... &th&emc=th

July 16, 2010
Drug Trials Test Bold Plan to Slow Alzheimer’s
By GINA KOLATA
Marilyn Maldonado is not quite sure why she is at the Memory Enhancement Center in the seaside town of Oakhurst, N.J.

“What are we waiting for?” she asks. About 10 minutes later, she asks again. Then she asks again.

She is waiting to enter a new type of Alzheimer’s drug study that will, in the boldest effort yet, test the leading hypothesis about how to slow or stop this terrifying brain disease.

The disease is defined by freckles of barnacle-like piles of a protein fragment, amyloid beta, in the brain. So, the current thinking goes, if you block amyloid formation or get rid of amyloid accumulations — plaque — and if you start treatment before the disease is well under way, you might have a chance to alter its course.

On Tuesday, that plan got a new push. The National Institute on Aging and the Alzheimer’s Association proposed new guidelines for diagnosis to find signs of Alzheimer’s in people who do not yet have severe symptoms, or even any symptoms at all.

The guidelines are needed for the new approach to Alzheimer’s drug development. Just about every pharmaceutical company and many biotechnology companies have experimental drugs to block amyloid — there are more than 100 in the pipeline. And the companies would like to show that if they give their drugs early, they can slow or stop the disease.

That is the ultimate goal for the drug in the study Mrs. Maldonado wants to enter, sponsored by Bristol-Myers Squibb. The company is, for the first time, testing such a drug in patients who, on evaluation with memory tests and new brain scans and tests for amyloid in cerebrospinal fluid, seem to be in a very early stage of Alzheimer’s. The idea is to attack the disease when there may still be time to stop the worst brain cell death.

But there is a problem. The Food and Drug Administration says it needs to know not just that plaque was reduced or even that it disappeared, but that those who took a drug ended up with better memory and better ability to think and reason as compared with those who did not take the drug.

Alzheimer’s, though, progresses so slowly that showing that a drug, started early, affects symptoms can take far longer than companies can afford to wait.
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July 19, 2010
Alzheimer’s Isn’t Up to the Tests
By SANJAY W. PIMPLIKAR
CLEVELAND

A PANEL of medical experts from the National Institute on Aging and the Alzheimer’s Association last week proposed changes in the way doctors diagnose Alzheimer’s disease — including the use of so-called biomarkers, tests like PET brain scans and analyses of spinal fluids to promote early detection of the disease. Although these recommendations are well intentioned, evidence suggests that it would be a mistake to adopt them at this time. To understand why, it’s important to recognize what these tests mean, in what context the information will be used and what experience has shown us.

First, about the diagnostic tests: A PET scan detects clumps of a deformed protein called amyloid beta, commonly known as plaques. The presence of these plaques has been a gold standard of Alzheimer’s pathology since 1906, when Dr. Alois Alzheimer first identified them in a patient.

However, we now know that roughly one-third of all elderly adults have such plaques in their brains yet function normally. And eleven clinical trials, recently made public by a group of drug companies, that were aimed at reducing these plaques in Alzheimer’s patients all failed to show cognitive improvement, even when the brains were cleared of plaques.

Thus, the presence of plaques cannot predict with any accuracy or specificity that an individual is going to acquire the disease — and researchers are increasingly looking beyond the amyloid hypothesis for an adequate explanation for Alzheimer’s.

Another test being recommended by the panel is spinal fluid analysis — which measures the relative levels of two proteins, tau and amyloid beta. This method does seem quite promising, but its predictive potential remains uncertain.

There are also practical issues to be considered, not least of all the high cost of these procedures. What’s more, the spinal tap procedure is not easy to perform and is painful to undergo, and it is a long way from becoming a routine diagnostic tool. Dr. Janis Petzel, a geriatric psychiatrist in Maine, has noted how unfeasible this test is in “nonacademic, rural or non-Western settings”: “I pray that cerebrospinal fluid findings will never be part of diagnostic criteria for Alzheimer’s disease,” she wrote.

The diagnostic tests themselves can carry a risk of side effects. General imaging scans can expose patients to radiation, for instance; an invasive spinal tap could result in infection or damage to tissue. But there is also the psychological risk of false positives and misdiagnoses that greatly distress patients, at least until further tests show they do not have the disease.

This danger of overdiagnosis is very real, as the history of treatment for prostate cancer shows. A study last year about the prostate-specific antigen test found that in the two decades after the test was introduced, prostate cancer was detected in more than 1 million additional men, many of whom were likely overtreated.

Last, the most dreadful thing about Alzheimer’s disease, next to the slow deterioration of cognition, is that we do not yet have a cure and none seems to be on the horizon. So, even if the new recommendations rendered the diagnosis earlier and unassailable, there is no therapeutic avenue to use this information to effectively treat the patient. Many individuals would simply prefer to be spared the emotional trauma of a diagnosis if no treatment exists.

Taken together, these reasons suggest that the panel’s recommendations are likely to increase the emotional burden on individuals and the financial burden on society without providing proportional benefits. The doctor’s most basic tenet is that of primum non nocere — first, do no harm. Until we have a more definite idea about what causes Alzheimer’s, early-detection tests may do patients more harm than good.


Sanjay W. Pimplikar is an associate professor in the department of neurosciences at the Cleveland Clinic’s Lerner Research Institute.
http://www.nytimes.com/2010/07/20/opini ... ?th&emc=th
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Post by kmaherali »

British researchers develop ‘cure’ for Type 2 diabetes: Starve yourself
By Thomas H. Maugh II / Los Angeles Times
Sunday, June 26, 2011 - Added 2 days ago


British researchers have developed what they say is a "cure" for Type 2 diabetes, the most common form of the disease. And all you have to do is starve yourself for eight weeks.

Roy Taylor, head of the magnetic resonance imaging unit at Newcastle University in Britain, and his colleagues studied 11 patients who had developed diabetes later in life and who had had it for several years. The patients averaged 220 pounds at the beginning of the study. Each was put on a 600-calorie-per-day diet that included a special diet drink and non-starchy vegetables, such as broccoli, asparagus and cabbage. The diet was followed for eight weeks.

Taylor reported Saturday at a San Diego meeting of the American Diabetes Association and in the journal Diabetologia that, after one week on the diet, each of the patients’ fasting blood sugar, taken before breakfast, had returned to normal. At the end of the eight weeks, the patients had lost an average of 33 pounds and had no signs of diabetes. Three months after returning to a normal diet, seven of them remained free of the disease. Average weight gain in that three months was 6.5 pounds.

Taylor believes he has an explanation for the results. At the beginning of the study, MRI scans of the patients’ pancreases showed that they held an elevated level of fat, 8 percent compared with the normal 6 percent. That extra fat impairs the organ’s ability to produce insulin, he speculated. At the end of the study, fat levels in the pancreas were down to normal in each patient.

"We believe that this shows that Type 2 diabetes is all about energy balance in the body," Taylor said in a statement. "If you are eating more (calories) than you burn, then the excess is stored in the liver and pancreas as fat, which can lead to Type 2 diabetes in some people. What we need to examine further is why some people are more susceptible to developing diabetes than others."

He added that, "We used the 600-calorie diet to test a hypothesis. What I can tell you definitively is that if people lose substantial weight by normal means, they will lose their diabetes."

An estimated 25 million Americans have Type 2 diabetes, in which the body does not respond properly to insulin produced by the pancreas. Experts recommend that patients consult with a doctor before attempting such an extreme diet.

http://www.bostonherald.com/jobfind/new ... ition=also
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Post by kmaherali »

July 16, 2011
Patrolling Cancer’s Borderlands
By SIDDHARTHA MUKHERJEE

THREE recent events highlight the extraordinary task that lies ahead for cancer prevention.

First: in late May, a World Health Organization panel added cellphones to a list of things that are “possibly carcinogenic” — a category that also includes pickles and coffee.

Second: in mid-June, the National Toxicology Program, countering years of lobbying by certain industries, finally classified formaldehyde (used in plywood manufacturing and embalming) as a carcinogen.

And third: in late June, the Food and Drug Administration issued newer and more graphic warning labels for cigarette packages. These include deliberately disturbing images of a patient with mouth cancer and of a man with tobacco smoke coming out of a tracheotomy stoma.

What connects these events? Together, they serve to remind us of three of the most potent challenges that cancer-control agencies face today. Indeed, it is essential to recognize these events as representing a progression: each corresponds to a crucial stage in the process of patrolling the borderlands of cancer. Effective cancer control depends on successful action at each of these complex stages.

The first challenge is scientific. It concerns the complexity of identifying new carcinogens, and the need for consistent standards for doing so. Take the purported link between cellphone radiation and brain cancer. This link is based largely on the so-called Interphone study. In Interphone, men and women with a variant of brain cancer (called glioma) were asked to recall their level of exposure to cellphone radiation. The results, at first glance, were provocative. Men and women who recalled moderate phone use seemed to have decreased rates of brain cancer compared to those who rarely used cellphones. In contrast, men and women with the highest usage seemed to have an increased rate of brain cancer.

But pivotal uncertainties remain. Trials like Interphone depend on the ability of subjects to recall their prior exposures. Such recollections can be surprisingly inconsistent. Indeed, when some subjects’ actual phone use was logged, there were broad discrepancies between actual and reported usage.

There are other difficulties. Despite a drastic increase in cellphone usage over the past decades, there has been no significant change in glioma cancer rates across the nation. Perhaps it is too early to judge, but the enormous increase in phone usage should have caused at least a minor blip in glioma rates over 20 years — but no such increase is apparent.

And finally, the kind of radiation emitted by cellphones — unlike the radiation emitted by X-rays or nuclear bombs — cannot directly damage DNA. X-rays and nuclear radiation possess the energy required to alter genes and thereby cause cancer. But the frequency of cellphone radiation is more than a million-fold lower. If cellphone radiation is causing cancer, it is doing so through a mechanism that defies our current understanding of carcinogenesis.

Brain cancer is a devastating illness, and it’s worth being cautious, but the current data supporting the link between phone radiation and glioma are weak. The cellphone case is a reminder of how difficult it is to identify a new carcinogen — and how important it therefore is to have standards to make such classifications possible.

Discrepancies in standards for classifying carcinogens have led to confusion and turmoil in the public realm. In contrast to the World Health Organization, many agencies, including the National Cancer Institute, remain skeptical about the link between phone radiation and cancer, and are awaiting more definitive studies to clarify the issue. In part, the problem is semantic: the W.H.O.’s definition of “possibly carcinogenic” is much looser; coffee and pickles are included, even though the evidence for their carcinogenicity remains weak. But the split between the W.H.O. and other agencies on cellphones — emblematic of the split within the scientific community — has had the unfortunate effect of confounding the public, which now does not know which faction to believe.

The second challenge facing cancer control agencies is political. The formaldehyde case illustrates this. Unlike phone radiation, formaldehyde has a well-established mechanism to cause cancer: it is a strikingly reactive chemical that can directly attack DNA. Experiments performed in the 1970s demonstrated that the chemical causes cancer in mice and rats. Following this data, sophisticated trials showed that men and women exposed to formaldehyde — morticians, for instance — had higher rates of leukemia than unexposed people.

But some of these studies were performed three decades ago. Why have 30 years elapsed between them and the National Toxicology Program announcement? In part, because of active lobbying by various industries, in particular, plywood manufacturers, who have tried to thwart this classification.

Identifying a carcinogen, in short, isn’t sufficient. Beyond the science — which, as the cellphone example shows, can be hard enough — cancer-control agencies need to bolster political support, and neutralize lobbying interests, before a culprit carcinogen can be revealed to the public.

The third challenge for the cancer community is social. The F.D.A.’s new labels on cigarette packages are a case in point. The human trials that established that tobacco smoke is a carcinogen were initially performed in the mid-1950s (some even earlier). The tobacco industry mounted an aggressive campaign to discredit the data, and continued marketing tobacco to the public. The landmark Surgeon General’s Report on smoking and cancer was released in 1964. And it took yet another decade of innovative strategies, including powerful antitobacco advertisements and tort cases against tobacco companies, to alter the trajectory of smoking behavior in America.

But young men and women in some parts of the nation are smoking again: consumption in certain regions has been rising, and cancer rates will rise concomitantly. Evidently, identifying a carcinogen or advertising the risk to the public is not enough: cancer-control agencies need to invent and reinvent strategies continuously. Old warning labels generate habitual responses, so new, more disturbing labels are needed to invigorate attention.

Patrolling the world for real carcinogens, in short, is a complex task. Scientific challenges morph into political challenges that lead to social challenges. If reducing the incidence of cancer is a national goal — as it surely must be — then it is essential to recognize the many-dimensional nature of countering carcinogens.

Siddhartha Mukherjee is an assistant professor of medicine at Columbia University and the author of “The Emperor of All Maladies: A Biography of Cancer.”

http://www.nytimes.com/2011/07/17/opini ... emc=tha212
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Post by kmaherali »

August 29, 2011
The Annals of Extreme Surgery
By BARRON H. LERNER

THE heat is on again in the world of cancer treatment, both literally and figuratively.

More and more doctors are now using an extremely aggressive procedure to treat certain colorectal and ovarian cancers called Hipec, in which patients first undergo surgery to remove any visible cancer, then have heated chemotherapy pumped into the abdominal cavity for 90 minutes to kill any remaining cells.

Although it has given some patients hope, there is almost no evidence that the treatment is more effective than traditional chemotherapy — besides one small trial in the Netherlands over a decade ago that did show a benefit, but in which 8 percent of the participants died from the procedure itself.

We shouldn’t be surprised by the sudden emergence of this therapy. Heated chemotherapy is the latest in a long list of very toxic treatments used by well-meaning cancer doctors who have confused doing more for patients with doing what is best for them.

History tells us that this “more is better” dictum is rarely true.

Aggressive cancer therapy started in the late 19th century with the radical mastectomy, which involved the removal of the breast, along with the chest muscle below it and nearby lymph nodes, and was championed by William S. Halsted, a surgeon at Johns Hopkins.

In the following decades, Dr. Halsted’s methods became more and more popular, particularly after World War II, when surgeons who had performed heroic operations on European battlefields returned to America optimistic about what could be achieved in cancer surgery. In an attempt to eradicate all potentially dangerous cells without the assistance of chemotherapy — which was not yet in wide use — surgeons began removing even parts of the sternum and rib cage of certain breast cancer patients in something called a super-radical mastectomy.

If the cancer had spread into the arms, surgeons at times removed entire shoulders (forequarter amputations). If the cancer was in the legs, part of the pelvis was removed with the leg (hindquarter amputations). The most aggressive operation of all was probably the pelvic exenteration, devised by the New York gynecologist Alexander Brunschwig. For cancers that had spread throughout a woman’s pelvis, he removed not only her gynecological organs but also her bladder and rectum.

The goal of these operations was straightforward: to remove as many cancer cells as possible, which would theoretically prolong the survival of patients and possibly even cure them. The problem was that none of these procedures had been formally tested in controlled clinical trials. By the 1960s, it had become clear that they were of little or no benefit, while causing dying cancer patients disfigurement and suffering.

Why such enthusiasm for aggressive surgery? The explanation can be gleaned from the language surgeons used to justify their operations. Military metaphors were ubiquitous. In 1946, Cushman Haagensen warned his colleagues against “surgical cowardice” in the face of the “formidable enemy” that was cancer. Jerome A. Urban, the father of the super-radical mastectomy, was fond of saying “lesser surgery is done by lesser surgeons.”

It was not only surgeons who made these assumptions. In the late 1980s, oncologists began treating metastatic breast cancer patients with a highly toxic and expensive regimen of so-called very-high-dose chemotherapy, followed by bone marrow transplants. Once again, early data proved misleading. Women who received this treatment turned out to live no longer than those getting standard chemotherapy, and many died from either the high doses or the side effects of the transplants.

Cancer patients and their families, desperate for anything that might work after exhausting all other treatment options, are also part of the problem. But the history of cancer treatment provides a crucial cautionary tale for both those seeking out and those providing heated chemotherapy today. Doing more for cancer patients has often served a cultural as opposed to a scientific purpose, reflecting more the desire to defeat the cancer enemy than to take care of sick patients. Hospitals should offer heated chemotherapy — and insurance companies should pay for it — only after controlled trials have proved its effectiveness.

In the meantime, we should remember not to conflate our efforts with our achievements.

Barron H. Lerner, a professor of medicine and public health at Columbia, is the author of “The Breast Cancer Wars: Hope, Fear and the Pursuit of a Cure in Twentieth-Century America” and the forthcoming “One for the Road: Drunk Driving Since 1900.”


http://www.nytimes.com/2011/08/30/opini ... emc=tha212
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Post by kmaherali »

September 26, 2011
Fighting Cervical Cancer With Vinegar and Ingenuity
By DONALD G. McNEIL Jr.

POYAI, Thailand — Maikaew Panomyai did a little dance coming out of the examination room, switching her hips, waving her fists in the air and crowing, in her limited English: “Everything’s O.K.! Everything’s O.K.!”

Translation: The nurse just told me I do not have cervical cancer, and even the little white spot I had treated three years ago is still gone.

What allowed the nurse to render that reassuring diagnosis was a remarkably simple, brief and inexpensive procedure, one with the potential to do for poor countries what the Pap smear did for rich ones: end cervical cancer’s reign as the No. 1 cancer killer of women. The magic ingredient? Household vinegar.

Every year, more than 250,000 women die of cervical cancer, nearly 85 percent of them in poor and middle-income countries. Decades ago, it killed more American women than any other cancer; now it lags far behind cancers of the lung, breast, colon and skin.

Nurses using the new procedure, developed by experts at the Johns Hopkins medical school in the 1990s and endorsed last year by the World Health Organization, brush vinegar on a woman’s cervix. It makes precancerous spots turn white. They can then be immediately frozen off with a metal probe cooled by a tank of carbon dioxide, available from any Coca-Cola bottling plant.

The procedure is one of a wide array of inexpensive but effective medical advances being tested in developing countries. New cheap diagnostic and surgical techniques, insecticides, drug regimens and prostheses are already beginning to save lives.

With a Pap smear, a doctor takes a scraping from the cervix, which is then sent to a laboratory to be scanned by a pathologist. Many poor countries lack high-quality labs, and the results can take weeks to arrive.

Women who return to distant areas where they live or work are often hard to reach, a problem if it turns out they have precancerous lesions.

Miss Maikaew, 37, could have been one of them. She is a restaurant cashier on faraway Ko Chang, a resort island. She was home in Poyai, a rice-farming village, for a brief visit and was screened at her mother’s urging.

The same thing had happened three years ago, and she did have a white spot then. (They resemble warts, and are caused by the human papillomavirus.) It was frozen off with cryotherapy, which had hurt a little, but was bearable, she said.

Since she has been screened twice in her 30s, her risk of developing cervical cancer has dropped by 65 percent, according to studies by the Alliance for Cervical Cancer Prevention, a coalition of international health organizations funded by the Bill & Melinda Gates Foundation.

The procedure, known as VIA/cryo for visualization of the cervix with acetic acid (vinegar) and treatment with cryotherapy, can be done by a nurse, and only one visit is needed to detect and kill an incipient cancer.

Thailand has gone further than any other nation in adopting it. More than 20 countries, including Ghana and Zimbabwe, have done pilot projects. But in Thailand, VIA/cryo is now routine in 29 of 75 provinces, and 500,000 of the 8 million women, ages 30 to 44, in the target population have been screened at least once.

Dr. Bandit Chumworathayi, a gynecologist at Khon Kaen University who helped run the first Thai study of VIA/cryo, explains that vinegar highlights the tumors because they have more DNA, and thus more protein and less water, than other tissue.

It reveals pre-tumors with more accuracy than a typical Pap smear. But it also has more false positives — spots that turn pale but are not malignant. As a result, some women get unnecessary cryotherapy.

But freezing is about 90 percent effective, and the main side effect is a burning sensation that fades in a day or two.

By contrast, biopsies, the old method, can cause bleeding.

“Some doctors resist” the cryotherapy approach, said Dr. Wachara Eamratsameekool, a gynecologist at rural Roi Et Hospital who helped pioneer the procedure. “They call it ‘poor care for poor people.’ This is a misunderstanding. It’s the most effective use of our resources.”

At a workshop, nurse trainees pored over flash cards showing cervixes with diagnosable problems. They did gynecological exams on lifelike mannequins with plastic cervixes. They performed cryotherapy on sliced frankfurters pinned deep inside plastic pipes. Then, after lunch, they broke into small groups and went by minibus to nearby rural clinics to practice on real women.

Because cervical cancer takes decades to develop, it is too early to prove that Thailand has lowered its cancer rate. In fact, Roi Et Province, where mass screening first began, has a rate higher than normal, but doctors attribute that to the extra testing. But of the 6,000 women recruited 11 years ago for the first trial, not a single one has developed full-blown cancer.

VIA/cryo was pioneered in the 1990s simultaneously by Dr. Paul D. Blumenthal, an American gynecologist working in Africa, and Dr. Rengaswamy Sankaranarayanan in India.

Dr. Blumenthal said he and colleagues at the Johns Hopkins medical school had debated ways to make cervical lesions easier to see, and concluded that whitening them with acetic acid would be effective. Freezing off lesions is routine in gynecology and dermatology; the challenge was making it cheap and easy. Liquid nitrogen is hard to get, but carbon dioxide is readily available.

Thailand seems made for the vinegar technique. It has more than 100,000 nurses and a network of rural clinics largely run by them.

Also, while poor rural villagers in many countries go to shamans or herbalists before they see doctors, poor Thais do not. Thailand has a 95 percent literacy rate, and doctors are trusted. The king is the son of a doctor and a nurse; his father trained at Harvard. One of the royal princesses has a doctorate in chemistry and an interest in cancer research.

But the real secret, Dr. Wachara said, is this: “Thailand has Lady Kobchitt.”

Dr. Kobchitt Limpaphayon to her colleagues at Bangkok’s Chulalongkorn University medical school and “Kobbie” to her classmates long ago at New York’s Albany Medical College, she is the gynecologist to the Thai royal family. “Kobbie is a force of nature,” said Dr. Blumenthal, who has taught with her. In 1971, as a young doctor, she moved from Albany to Baltimore to help start the Johns Hopkins Program for International Education in Gynecology and Obstetrics.

In 1999, she read one of Dr. Blumenthal’s papers and asked him to introduce VIA/cryo in Thailand. Without her connections and powers of persuasion, said Dr. Bandit, it would have been impossible to get the conservative Royal Thai College of Obstetricians and Gynecologists to give up Pap smears, or to persuade Parliament to allow nurses to do cryotherapy, a procedure previously reserved for doctors.

The free screenings at public clinics are crucial to people like Yupin Promasorn, 36, who was part of Miss Maikaew’s group.

She sells snacks in Bangkok, and her husband drives a tuk-tuk motorcycle taxi. With two children, she has no time to wait at Bangkok’s jammed public hospitals, and she is too poor to see a private doctor. So she and her husband drove the 12 hours here, to her native village, in his tuk-tuk. When she found out she was negative, she sat in a chair fanning herself.

“I feel like a heavy mountain is gone from my chest,” she said.

http://www.nytimes.com/2011/09/27/healt ... emc=tha210
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Post by kmaherali »

October 6, 2011
U.S. Panel Says No to Prostate Screening for Healthy Men
By GARDINER HARRIS

Healthy men should no longer receive a P.S.A. blood test to screen for prostate cancer because the test does not save lives over all and often leads to more tests and treatments that needlessly cause pain, impotence and incontinence in many, a key government health panel has decided.

The draft recommendation, by the United States Preventive Services Task Force and due for official release next week, is based on the results of five well-controlled clinical trials and could substantially change the care given to men 50 and older. There are 44 million such men in the United States, and 33 million of them have already had a P.S.A. test — sometimes without their knowledge — during routine physicals.

The task force’s recommendations are followed by most medical groups. Two years ago the task force recommended that women in their 40s should no longer get routine mammograms, setting off a firestorm of controversy. The recommendation to avoid the P.S.A. test is even more forceful and applies to healthy men of all ages.

“Unfortunately, the evidence now shows that this test does not save men’s lives,” said Dr. Virginia Moyer, a professor of pediatrics at Baylor College of Medicine and chairwoman of the task force. “This test cannot tell the difference between cancers that will and will not affect a man during his natural lifetime. We need to find one that does.”

More...

http://www.nytimes.com/2011/10/07/healt ... s&emc=tha2

*****
Can Cancer Ever Be Ignored?

http://www.nytimes.com/2011/10/09/magaz ... emc=tha210

Excerpt:

"Cancer screening is a growing field; existing tests are becoming more sensitive, and new tests are constantly developed. We now have CT scanning for lung cancer, and there is also a blood test marketed by Johnson & Johnson known as a “liquid biopsy,” which searches for stray cancer cells in the bloodstream. More testing inevitably brings more treatment, because the urge to correct every cellular anomaly, no matter how small or potentially harmless, is practically irresistible. But if there is one lesson from the P.S.A. test, it is that more information and intervention do not always lead to less suffering."
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Post by kmaherali »

New Procedure of CPR.

This short video illustrates the best demonstration and gives the simplest explanation of exactly what to do if someone near you collapses and is presumably having a heart attack.

This is a video of University of Arizona http://medicine.arizona.edu/spotlight/l ... ession-cpr
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Post by kmaherali »

May 2, 2012

How Chemicals Affect Us

By NICHOLAS D. KRISTOF

Scientists are observing with increasing alarm that some very common hormone-mimicking chemicals can have grotesque effects.

A widely used herbicide acts as a female hormone and feminizes male animals in the wild. Thus male frogs can have female organs, and some male fish actually produce eggs. In a Florida lake contaminated by these chemicals, male alligators have tiny penises.

These days there is also growing evidence linking this class of chemicals to problems in humans. These include breast cancer, infertility, low sperm counts, genital deformities, early menstruation and even diabetes and obesity.

Philip Landrigan, a professor of pediatrics at Mount Sinai School of Medicine, says that a congenital defect called hypospadias — a misplacement of the urethra — is now twice as common among newborn boys as it used to be. He suspects endocrine disruptors, so called because they can wreak havoc with the endocrine system that governs hormones.

Endocrine disruptors are everywhere. They’re in thermal receipts that come out of gas pumps and A.T.M.’s. They’re in canned foods, cosmetics, plastics and food packaging. Test your blood or urine, and you’ll surely find them there, as well as in human breast milk and in cord blood of newborn babies.

In this campaign year, we are bound to hear endless complaints about excessive government regulation. But here’s an area where scientists are increasingly critical of our government for its failure to tackle Big Chem and regulate endocrine disruptors adequately.

Last month, the Endocrine Society, the leading association of hormone experts, scolded the Food and Drug Administration for its failure to ban bisphenol-A, a common endocrine disruptor known as BPA, from food packaging. Last year, eight medical organizations representing genetics, gynecology, urology and other fields made a joint call in Science magazine for tighter regulation of endocrine disruptors.

Shouldn’t our government be as vigilant about threats in our grocery stores as in the mountains of Afghanistan?

Researchers warn that endocrine disruptors can trigger hormonal changes in the body that may not show up for decades. One called DES, a synthetic form of estrogen, was once routinely given to pregnant women to prevent miscarriage or morning sickness, and it did little harm to the women themselves. But it turned out to cause vaginal cancer and breast cancer decades later in their daughters, so it is now banned.

Scientists have long known the tiniest variations in hormone levels influence fetal development. For example, a female twin is very slightly masculinized if the other twin is a male, because she is exposed to some of his hormones. Studies have found that these female twins, on average, end up slightly more aggressive and sensation-seeking as adults but have lower rates of eating disorders.

Now experts worry that endocrine disruptors have similar effects, acting as hormones and swamping the delicate balance for fetuses in particular. The latest initiative by scholars is a landmark 78-page analysis to be published next month in Endocrine Reviews, the leading publication in the field.

“Fundamental changes in chemical testing and safety determination are needed to protect human health,” the analysis declares. Linda S. Birnbaum, the nation’s chief environmental scientist and toxicologist, endorsed the findings.

The article was written by a 12-member panel that spent three years reviewing the evidence. It concluded that the nation’s safety system for endocrine disruptors is broken.

“For several well-studied endocrine disruptors, I think it is fair to say that we have enough data to conclude that these chemicals are not safe for human populations,” said Laura Vandenberg, a Tufts University developmental biologist who was the lead writer for the panel.

Worrying new research on the long-term effects of these chemicals is constantly being published. One study found that pregnant women who have higher levels of a common endocrine disruptor, PFOA, are three times as likely to have daughters who grow up to be overweight. Yet PFOA is unavoidable. It is in everything from microwave popcorn bags to carpet-cleaning solutions.

Big Chem says all this is sensationalist science. So far, it has blocked strict regulation in the United States, even as Europe and Canada have adopted tighter controls on endocrine disruptors.

Yes, there are uncertainties. But the scientists who know endocrine disruptors best overwhelmingly are already taking steps to protect their families. John Peterson Myers, chief scientist at Environmental Health Sciences and a co-author of the new analysis, said that his family had stopped buying canned food.

“We don’t microwave in plastic,” he added. “We don’t use pesticides in our house. I refuse receipts whenever I can. My default request at the A.T.M., known to my bank, is ‘no receipt.’ I never ask for a receipt from a gas station.”

I’m taking my cue from the experts, and I wish the Obama administration would as well.

I invite you to visit my blog, On the Ground. Please also join me on Facebook and Google+, watch my YouTube videos and follow me on Twitter.

http://www.nytimes.com/2012/05/03/opini ... h_20120503
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Post by kmaherali »

Opinion
Rethinking Sleep
By DAVID K. RANDALL
It's not the quantity of sleep that restores and refreshes, but the quality.

http://www.nytimes.com/2012/09/23/opini ... h_20120923

Excerpt:

Typically, mention of our ever increasing sleeplessness is followed by calls for earlier bedtimes and a longer night’s sleep. But this directive may be part of the problem. Rather than helping us to get more rest, the tyranny of the eight-hour block reinforces a narrow conception of sleep and how we should approach it. Some of the time we spend tossing and turning may even result from misconceptions about sleep and our bodily needs: in fact neither our bodies nor our brains are built for the roughly one-third of our lives that we spend in bed.

The idea that we should sleep in eight-hour chunks is relatively recent. The world’s population sleeps in various and surprising ways. Millions of Chinese workers continue to put their heads on their desks for a nap of an hour or so after lunch, for example, and daytime napping is common from India to Spain.
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Post by Admin »

Murad Sarfani sent a message using the contact form at

My name is Murad Sarfani Ismaili Muslim , I live in Memphis Tn usa and I
used to live a very healthy life . One day I was addicted to this tobacco
chewing habits and continued doing this for a long time , which made be
landed into a severe cancer into my mouth at last stage ,I went through a
very tough and long surgery process , where I was fortunate to let this
surgery be a success. At that time I realize that I would have not adopted
this habit , which took me into a deep trouble .

Well after going through all this I have been effected with lot of uneven
circumstances like my family was hurt , I made my parents and friends very feel bad , finance hassles and many other things where at one stage I thought that WHAT MADE ME DO THIS .

But after going through all this I realize that this was not how we live
our beautiful life with having addicted to tobacco , alcohol and pan masala
, I tried to show my life in this visual to make you all understand that a
simple mistake cost us with such painful ride.

I request ismaili net that is there anyway that I can be used in helping
jamat and community to make them understand that how dangerous is this ride , where I can use my personal videos and pictures to help them understand to stop before tobacco stops them and I will plan all my travel
arrangements and finance on my own , just it's a very humble wish to bring more happiness in them families of tobacco and alcohol users and let them start a fresh life with a new beginning and bring revolution to help those who really don't understand the losses .

Let's stand together shoulder to shoulder and join hands together and
let's bring this awareness of not to use this tobacco in future and help
create more and more stronger chain to show this world that even after
given up the habit of tobacco , we are together strong enough to help
anybody whom they would join us to save this precious life .

CANCER AWARENESS MURAD VIDEO
https://www.youtube.com/watch?v=cc8H6vD40Yo

FACEBOOK

MURAD SARFANI
https://m.facebook.com/NooneTobacco
Please join and help me spread this awareness around the world to stop
tobacco before it stops them and lets create to live tobacco free life.

My contact info

Murad Sarfani
210 639 3960
muradsarfani [at] gmail.com
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Post by kmaherali »

The Myth of High-Protein Diets

Other physicians, including Dr. Kim A. Williams, the president of the American College of Cardiology, are also finding that these diet and lifestyle changes can reduce the need for a lifetime of medications and transform people’s lives. These changes may also slow, stop or even reverse the progression of early-stage prostate cancer, judging from results in a randomized controlled trial.

These changes may also alter your genes, turning on genes that keep you healthy, and turning off genes that promote disease. They may even lengthen telomeres, the ends of our chromosomes that control aging.

The more people adhered to these recommendations (including reducing the amount of fat and cholesterol they consumed), the more improvement we measured — at any age. But for reversing disease, a whole-foods, plant-based diet seems to be necessary.

In addition, what’s good for you is good for our planet. Livestock production causes more disruption of the climate than all forms of transportation combined. And because it takes as much as 10 times more grain to produce the same amount of calories through livestock as through direct grain consumption, eating a plant-based diet could free up resources for the hungry.

What you gain is so much more than what you give up.
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http://www.nytimes.com/2015/03/23/opini ... 05309&_r=0
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Post by kmaherali »

Stemming the Tide of Fake Medicines

A flood of fraudulent medicines sold mostly in the developing world is threatening the health of hundreds of thousands, if not millions, of people in those nations and consumers in more advanced nations as well.

International organizations, national drug regulators and the drug industry itself have been struggling for years to curb sales of phony or poorly prepared medicines. But articles in a special issue of the American Journal of Tropical Medicine and Hygiene, published online last month, show that efforts to control this problem have had only modest success over the past decade.

The number of outright fakes — pills containing no active ingredients at all — may have declined. However, the problem of substandard medicines that have some, but not all, of the active ingredient they are supposed to contain has worsened. Sometimes a medicine degrades because it has not been stored or handled properly. But often the manufacturer deliberately reduces the amount of active ingredients to save money while increasing inert ingredients to keep the weight and shape the same.

Substandard medicines — a pill, for instance, that has 70 to 80 percent of the active ingredient — may actually accelerate the development of resistant germs. The dose is not enough to eliminate all the targeted germs, and those that remain are the most resistant to the drug. The resistant strains can then infect new people.

Anti-malaria drugs are a particular problem. One study in the journal estimated that more than 120,000 children in sub-Saharan countries under the age of 5 died in 2013 because of ineffective malaria medicines. Another study found that, in Laos, the samples tested in 2012 had correct ingredients, but about one-fourth of them had fewer active ingredients than they should.

Similar problems beset antibiotics. A study of 35 samples of amoxicillin and co-trimoxazole purchased in Ghana, Nigeria and Britain found that 60 percent of the tablets of co-trimoxazole did not have the requisite amount of active ingredient. A study in Southeast Asia found that 65 percent of the ampicillin samples were substandard.

What can be done to stop the abuses? Poor countries need financial help, technical assistance and training to improve their oversight of medicines.

More affluent developing countries like China and India, whose companies make many of the substandard drugs, need to crack down on the wrongdoers. And punishments for knowingly or negligently making or selling fake medicines need to be severe, especially for those who sell medicines on the World Health Organization’s list of essential drugs.

Congress is considering ways to modernize drug regulation at the Food and Drug Administration to speed clinical trials and get drugs to market faster. It should also look at how the agency, acting on its own or through international organizations, might help rein in bogus drugs in an increasingly global market that can affect all consumers.

http://www.nytimes.com/2015/05/18/opini ... 05309&_r=0
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Global Diabetes Rates Are Rising as Obesity Spreads

WASHINGTON — The global diabetes rate has risen by nearly half over the past two decades, according to a new study, as obesity and the health problems it spawns have taken hold across the developing world.

The prevalence of diabetes has been rising in rich countries for several decades, largely driven by increases in the rate of obesity. More recently, poorer countries have begun to follow the trend, with major increases in countries like China, Mexico and India.

The study, published Monday in the British medical journal The Lancet, reported a 45 percent rise in the prevalence of diabetes worldwide from 1990 to 2013. Nearly all the rise was in Type 2, which is usually related to obesity and is the most common form of the disease.

A major shift is underway in the developing world, in which deaths from communicable diseases like malaria and tuberculosis have declined sharply, and chronic diseases like cancer and diabetes are on the rise. The pattern is linked to economic improvement and more people living longer, but it has left governments in developing countries scrambling to deal with new and often more expensive ways to treat illnesses.

The study, led by the Institute for Health Metrics and Evaluation, a research group, was funded by the Bill and Melinda Gates Foundation. It is the largest analysis of global disability data to date, drawing on more than 35,000 data sources in 188 countries.

The study measured the burden of disability by calculating the proportion of a population living with any given disorder in a year. It found that the numbers of people living with disability have gone up — largely a result of population growth and aging — but that the rate of disability declined slightly, dropping to 110 per 1,000 people in 2013, compared with 114 per 1,000 in 1990.

Nor had the top-ranking disabilities changed much. The top five were lower back pain, major depression, iron deficiency anemia, neck pain, and hearing loss from aging. In a stark illustration of the decline of infectious diseases in many countries, diarrheal diseases fell to 25th place from 15th. But diabetes increased as a share of the overall burden of disability, moving to No. 7 in 2013 from No. 10 in 1990.

China helped drive the rise in the global toll of diabetes. The prevalence of the disease there increased by about 56 percent over the period of the study.

But it was not the country with the largest rise. In the United States, the rate increased by 71 percent, and in Saudi Arabia by 60 percent. In Mexico it rose by 52 percent.

Saudi Arabia led the pack in terms of overall prevalence with 17,817 cases per 100,000 people in 2013 — more than double China’s 6,480 per 100,000. For comparison, the rate in the United States was roughly the same as China’s — 6,630 per 100,000, according to Amy VanderZanden, a data coordinator at the institute.

Theo Vos, a professor of global health at the institute, which is based at the University of Washington, noted that while the prevalence of diabetes had greatly increased, death rates from the disease had slowed substantially. People with diabetes are living longer, he said, in part because medical systems have gotten better at preventing people from dying from its complications.

In the United States, rates of diabetes complications including heart attacks, strokes, kidney failure and amputations fell sharply over the past two decades, in part the result of better medical care, monitoring and medications. Middle-income countries like China have gotten better at treating the illness too, Professor Vos said.

“On balance the burden is coming down — it’s better to be alive, even if you have disability,” he said. “But the downside is that it requires much more health system resources to treat people with these chronic problems.”

Investments in the health systems of low-income countries have long been geared toward treating infectious disease, a pattern that needs to change, he said.

http://www.nytimes.com/2015/06/08/healt ... ticle&_r=0
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The brainJune 10, 2015 8:00 a.m.
How One Brain Came Back From Unconsciousness
By Stephen S. Hall


Despite its encircling fortress of bone, the human brain is especially vulnerable to physical insult. There are approximately 1.7 million traumatic brain injuries in the United States each year, and although most of them are mild or moderate, thousands result in severe brain damage. Those injuries always happen on the same day: day zero, a day that marks the start of a fateful and often flawed prognostic calendar.

More....

http://nymag.com/scienceofus/2015/06/dy ... -coma.html
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In China, Illegal Drugs Are Sold Online in an Unbridled Market

SHANGHAI — Ordering illegal drugs from China is as easy as typing on a keyboard.

On guidechem.com, more than 150 Chinese companies sell alpha-PVP, also known as flakka, a dangerous stimulant that is illegal in the United States but not in China, and was blamed for 18 recent deaths in one Florida county.

The e-commerce portal Qinjiayuan sells air-conditioners, trampolines and a banned hallucinogen known as spice, which set off a devastating spike in United States emergency room visits in April.

The stimulant mephedrone, sometimes sold as “bath salts,” is banned in China but readily for sale at the Nanjing Takanobu Chemical Company for about $1,400 a pound.

“I can handle this for you legally or illegally,” a company salesman said by phone when asked about shipping the product overseas from the company’s headquarters in coastal Jiangsu Province. “How much do you want?”


A packet of spice. Marketed as potpourri or incense, it has led to a surge in emergency room visits in recent months.

Arrest Underscores China’s Role in the Making and Spread of a Lethal DrugMAY 28, 2015


In a country that has perfected the art of Internet censorship, the open online drug market is just the most blatant example of what international law enforcement officials say is China’s reluctance to take action as it has emerged as a major player in the global supply chain for synthetic drugs.

More....

http://www.nytimes.com/2015/06/22/world ... 05309&_r=0
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Can you prescribe nature?

"Here's your prescription, walk in the forest five times a week for an hour."

According to experts, it is not inconceivable that doctors will be giving health advice like this in the not too distant future.

After decades of research, the scientific world is moving closer to pinpointing how exposure to nature seems to promote well-being.

A recent US study found that being close to nature might soothe the mind by reducing rumination - when negative thoughts get stuck on repeat, playing over and over in the mind.

We evolved with nature and it's completely unnatural for us to be separated from itNigel Dunnett,, University of Sheffield

A team at Stanford University compared the effects of taking a nature walk through a greenspace with a stroll in an urban environment - in this case beside a busy road in Palo Alto.

Brain scans showed reduced activity in an area of the brain linked to risk of mental illness in participants who took a 90-minute walk among oaks, birds and squirrels.

They also reported lower levels of rumination.

Gregory Bratman of Stanford University, one of the researchers on the study, says moving to cities has "happened in a blink of an eye in terms of human evolution".

As he points out, never before have so many of us been removed from nature - already 50% of the global population lives in towns and cities; a figure that is projected to rise to 70% by 2050.

Some cities and nations are already thinking about the mental health benefits of nature when designing urban areas.

"There's an increasing body of evidence showing that natural versus urban areas benefit us at least emotionally with our mood and possibly also our cognitive development too," says Mr Bratman.

"You could think of these mental health benefits of nature as a psychological ecosystem service."

The Stanford University team is looking at ways to tease apart the "active ingredients" of the nature experience to find ways to bring nature into the city.

Greening up towns

Meanwhile, Britain's Royal Horticultural Society is trying to encourage the public to bring nature into their own backyard, by replacing concrete with plants.

A garden at the Hampton Court Flower Show for the Greening Grey Britain campaign showcased ways to make urban environments rich in both vegetation and nature.
Nigel Dunnett's garden at the RHS flower show aiming to turn grey space green
Plants from the garden are to be moved to Bristol to green-up a street for the community, including St Mungo's hostel for the homeless.

Nigel Dunnett, Professor of planting design and vegetation technology at the University of Sheffield, is behind the garden.

He says we "evolved with nature and it's completely unnatural for us to be separated from it".

He wants a shift in thinking to make developers invest in providing natural surroundings and for horticulturalists to get involved in green infrastructure projects.

"There is a big role for horticulture in this whole movement of greening cities," he adds.

"We have to be really radical, really innovative to get into places where you normally wouldn't get to see things growing."

Forest bathing

One health trend that is popular mainly in Japan and South Korea is Shinrin-yoku, a term that means "taking in the forest atmosphere" or "forest bathing".

A study conducted in 24 forests across Japan found that walking among trees lowered blood pressure, the pulse rate, and levels of the hormone cortisol, which is released in response to stress.

According to psychologist Dr Mathew White of Exeter University, research into the link between nature and well-being is increasingly focussing on effects on the body and brain, such as how brain activity corresponds with the nature experience.

"It does start to tell us some of the cognitive elements that could be at play in why urban environments are so taxing to the brain," he says.

He says several projects are underway to try to develop "green prescriptions" for exposure to nature that would be of benefit people going through anxiety or depression.

The Stanford University research is published in the journal, Proceedings of the National Academy of Sciences.

http://www.bbc.com/news/science-environment-33368691
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Is There Anything That Walking Can't Do?

1. Develop the memory of an elephant: Studies have shown, particularly for senior citizens, that walking improves memory skills as well as concentration and abstract reasoning.

2. Mr. Einstein, I presume: Walking improves concentration and abstract reasoning and increased cognitive functioning.

3. Reduce risk of stroke: cut that by 57% just by walking 20 minutes a day.

4. Get heart healthy: a study of women showed that those who walked three hours or more per week reduced risk of a coronary event by 35%/

5. Looking good: walking helps to keep you fit and wards off those sly extra pounds.

6. Feeling good: a recent study found that after 12 weeks, the further a woman walked, the better she feels about her appearance.

7. C’mon get happy: Just 30 minutes, three to five times per week for 12 weeks reduced symptoms of depression by 47%.

8. Lowered risk of diabetes: reduce risk of type 2 diabetes in high-risk individuals.

9. Lowered risk of cancer: 30 minutes daily reduce risk of colon cancer by up to 50%, as well as decreasing lung, breast and prostate cancers.

10. Nice bones: postmenopausal women who walk about a mile a day have better whole-bone density.

11. Live long and walk: 30 minutes of walking a day adds 1.3 healthy years.

http://www.travelsmart.ca/en/GVRD/Walki ... ot-Do.aspx
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Expanding waistlines will cause 3,500 more cancers each year, study finds

Scientists hope that linking 12,000 cancers each year to people being overweight will spark more action against obesity

Around 12,000 cancers a year are caused by people being overweight, according to a study which scientists hope will inspire more action to curb the obesity epidemic.

The study, published in the Lancet medical journal, is the biggest of its kind, involving data from 5 million UK adults. It finds that excess weight is linked to 10 different cancers, including cervical cancer, breast cancer and leukaemia.

The strongest links were in cancer of the womb, where excess weight was responsible for 41% of cases and in gallbladder, kidney, liver, and colon cancers, where it caused 10% or more.

Cancers have many causes – some of them genetic and some environmental. But the researchers, from the London School of Hygiene and Tropical Medicine (LSHTM) and the Farr Institute of Health Informatics, have taken account of all the other factors involved in order to come up with a good estimate of the actual number of cancers that could be prevented if people kept to a normal weight.

"If we could magically remove excess weight from the population, we would have 12,000 fewer cancers," said study leader Dr Krishnan Bhaskaran, National Institute for Health Research Postdoctoral Fellow at the LSHTM, who said that team members were surprised themselves at the strength of the relationship. "The number of people who are overweight or obese is rapidly increasing both in the UK and worldwide. It is well recognised that this is likely to cause more diabetes and cardiovascular disease. Our results show that if these trends continue, we can also expect to see substantially more cancers as a result."

The researchers looked at data from GP records on 5.24 million individuals over the age of 16, which included details of height and weight, from which they could calculate their body mass index (BMI) – a ratio of kg/m used to indicate whether or not people are overweight. They looked at the 22 most common cancers and found excess weight associated with 17 of them.


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Each 5kg/m increase in BMI was clearly linked with higher risk of cancers of the uterus (62% increase), gallbladder (31%), kidney (25%), cervix (10%), thyroid (9%), and leukaemia (9%). Higher BMI also increased the overall risk of liver (19% increase), colon (10%), ovarian (9%), and breast cancers (5%) but there were other variables.

Dr Bhaskaran said he hoped the findings would help governments take "courageous action" to tackle the obesity. "It will require action in various different areas. We need to look at how the most offending foods are the cheapest and most available and how [towns] are not set up for activity. We need support for people to lose weight. It is a big challenge."

In a linked commentary in the journal, Dr Peter Campbell from the American Cancer Society said the case for action is already clear and that braver political leadership is needed. "We have sufficient evidence that obesity is an important cause of unnecessary suffering and death from many forms of cancer. More research is not needed to justify, or even demand, policy changes aimed at curbing overweight and obesity.

"Some of these policy strategies have been enumerated recently, all of which focus on reducing caloric intake or increasing physical activity, and include taxes on calorically dense, nutritionally sparse foods such as sugar-sweetened beverages; subsidies for healthier foods, especially in economically disadvantaged groups; agricultural policy changes; and urban planning aimed at encouraging walking and other modes of physical activity.

"Research strategies that identify population-wide or community-based interventions and policies that effectively reduce overweight and obesity should be particularly encouraged and supported. Moreover, we need a political environment, and politicians with sufficient courage, to implement such policies effectively."

http://www.theguardian.com/society/2014 ... esearchers
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