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.”
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.
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.”
"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."
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.
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.
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 .
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.
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.
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.
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.
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.
"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."
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.
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.
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."
Children Die Because People Are Wrongly Afraid of Vaccines
Of all the threats to human life confronted by international health workers, few cause as heavy a toll as what is termed “vaccine hesitancy” — the delay or refusal by misinformed people to accept vaccination for themselves and their children. An estimated one in five children went without lifesaving vaccines globally last year, adding to the grim toll of 1.5 million children who die annually for lack of immunization, according to the World Health Organization.
This problem is only compounded by the challenge workers face in convincing skeptical publics to put aside what science shows are local myths and dangerous indifference. Citing the fight against Ebola, Dr. Philippe Duclos, senior adviser for the W.H.O.’s immunization programs, noted how “engaging with communities and persuading individuals to change their habits and behaviors is a linchpin of public health success.” Unfortunately, there is no easy prescription for how to change these habits.
The resistance to vaccines is worldwide, encompassing rural ethnic minorities opposed to needles to wealthy urbanites with suspicions about whether vaccines cause autism. At one extreme is the vicious use of force by Taliban gunmen who murder polio vaccination workers, thereby assuring that hundreds of children were crippled last year. No less insidiously, even greater numbers died globally from a wide range of diseases encouraged by the ignorance of adults who failed to accept immunization for their families.
Religious or philosophical objections play a role, according to experts who have found that not even a higher level of education is a guarantee against vaccine hesitancy. All of this only compounds the subtle challenges of enforcement and education that health care workers and governments have no choice but to pursue, since the lives of millions of children remain at risk.
Lower Blood Pressure Guidelines Could Be ‘Lifesaving,’ Federal Study Says
Declaring they had “potentially lifesaving information,” federal health officials said on Friday that they were ending a major study more than a year early because it has already conclusively answered a question cardiologists have puzzled over for decades: How low should blood pressure go?
The answer: way lower than the current guidelines.
For years doctors have been uncertain what the optimal goal should be for patients with high blood pressure. The aim of course is to bring it down, but how far and how aggressively remained a mystery. There are trade-offs — risks and side effects from drugs — and there were lingering questions about whether older patients needed somewhat higher blood pressure to push blood to the brain.
The study found that patients who were assigned to reach a systolic blood pressure goal below 120 — far lower than current guidelines of 140, or 150 for people over 60 — had their risk of heart attacks, heart failure and strokes reduced by a third and their risk of death reduced by nearly a quarter.
Blood seeping from the walls, killer doctors: ICU hallucinations haunt a staggering number of patients
Tens of thousands of Canadians who survive a life-threatening illness or injury every year are left with new and profound thinking, memory and psychological problems that can make them feel as if they are losing their minds, say Canadian researchers leading the largest study of its kind of ICU “survivors” and their caregivers.
The problems can linger for months, sometimes years. Some people never recover.
The phenomenon has been dubbed “post-intensive care syndrome.” It is a constellation of symptoms that can include devastating muscle weakness, cognitive dysfunction on the order of early Alzheimer’s disease or moderate traumatic brain injury, anxiety, depression and full-blown post-traumatic stress disorder.
One study published in April found 25 per cent of those who survive an ICU admission have symptoms of post-traumatic stress disorder (PTSD) between one and six months after leaving hospital.
That’s as high as those seen in combat soldiers or victims of rape, says the study’s co-author Dr. Dale Needham, a Canadian-born and trained doctor, now a professor of medicine at Johns Hopkins University School of Medicine in Baltimore.
They become the “forgotten patients,” experts say, struggling to understand why they’re having such a hard time returning to “normal” after being pulled from death.
The World Health Organization issued sweeping new guidelines on Wednesday that could put millions more people on H.I.V. drugs than are now getting them. The recommendations could go a long way toward halting the epidemic, health officials say, but would cost untold billions of dollars not yet committed.
H.I.V patients should be put on an antiretroviral therapy of three drugs immediately after diagnosis, the agency said, and everyone at risk of becoming infected should be offered protective doses of similar drugs.
Immediate treatment has become the standard of care in America and much of the developed world, but the agency’s new H.I.V. treatment and prevention guidelines increase by nine million the number of infected people who should get it worldwide.
The health agency did not estimate how many at-risk people would benefit from its new prevention guidelines, but Unaids, the United Nations AIDS fighting agency, made a back-of-the-envelope calculation that 10 million could be helped, including many women and girls in Africa not previously covered.
Numerous recent studies have shown that people taking so-called triple therapy every day not only live longer, but also have so little circulating virus that they are highly unlikely to infect others even through unprotected sex. Studies using Truvada, a two-drug combination taken preventively, have shown that those taking the drugs every day have near-total protection against infection.
The recommendations underscored the difference in options available to patients in industrialized countries and those in the developing world, and public health advocates acknowledged that it was unclear where the money would come from to turn the new guidelines into reality. Donor contributions for AIDS have been essentially flat since 2009. Although the W.H.O. issues guidelines, each country sets its own policy. Inevitably, when treatment starts depends on how many citizens the country’s health budget can afford to treat. Fifteen million people are on treatment now, fewer than half of the 37 million people infected worldwide.
As we move forwards, the Imam watches what is ahead, he thinks about what is ahead, and he seeks to guide his Jamat so that they position themselves properly for the future.There have been changes in the last decades in sickness among human beings.The nature of sickness fifty years ago is not what it is today.Sickness has moved from essentially being communicable disease-that is, a sickness that you can pass to other people-to non-communicable disease-which is disease which is yours, it cannot be communicated by you to other people.But non-communicable disease is becoming a significant problem in the Jamat and other communities around the world.
And what I am talking about cancer, I am talking about heart condition, and these are sicknesses which do not reveal themselves early; they are what we call in English "insidious". They are there but you do not know they are there,and,when they manifest themselves, it is often difficult to cure them. So I say to my spiritual children today; be wise, go for regular checkups,and the earlier that you know that you have a problem, the greater the chance of solving it.So be aware of the fact that ill-health is no longer what used to be fifty years ago,and be regular in your checkups.This is material advice, but it is my observation that my Jamats are exposed to the same issues as other communities around the world.
.....Acceptance of Jamati Mehmanis
LUCKNOW, India — What if there were a remedy that could save more children’s lives in the developing world than are claimed by malaria and AIDS combined?
A miracle substance that reduces ear infections while seeming to raise scores on I.Q. tests by several points? Available even in the most remote villages, requiring no electricity or refrigeration? Oh, and as long as we’re dreaming, let’s make it free.
This miracle substance already exists. It’s breast milk.
THERE has been an alarming and steady increase in the mortality rate of middle-aged white Americans since 1999, according to a study published last week. This increase — half a percent annually — contrasts starkly with decreasing death rates in all other age and ethnic groups and with middle-aged people in other developed countries.
So what is killing middle-aged white Americans? Much of the excess death is attributable to suicide and drug and alcohol poisonings. Opioid painkillers like OxyContin prescribed by physicians contribute significantly to these drug overdoses.
Thus, it seems that an opioid overdose epidemic is at the heart of this rise in white middle-age mortality. The rate of death from prescription opioids in the United States increased more than fourfold between 1999 and 2010, dwarfing the combined mortality from heroin and cocaine. In 2013 alone, opioids were involved in 37 percent of all fatal drug overdoses.
Driving this opioid epidemic, in large part, is a disturbing change in the attitude within the medical profession about the use of these drugs to treat pain. Traditionally, opioid analgesics were largely used to treat pain stemming from terminal diseases like cancer, or for short-term uses, such as recovering from surgery.
But starting in the 1990s, there has been a vast expansion in the long-term use of opioid painkillers to treat chronic nonmalignant medical conditions, like low-back pain, sciatica and various musculoskeletal problems. To no small degree, this change in clinical practice was encouraged through aggressive marketing by drug companies that made new and powerful opioids, like OxyContin, an extended-release form of oxycodone that was approved for use in 1995.
WASHINGTON — New data from the World Health Organization shows that we have allowed a preventable, curable disease to become the world’s biggest communicable killer. The millenniums-old lung disease tuberculosis now outranks even H.I.V./AIDS in the number of lives it claims. The fact is that we’ve been very successful at curing people of TB since the 1950s — so why is this illness still such a scourge?
TB is an airborne infectious disease. If untreated, one person with TB can infect 10 to 15 others in the space of a year. The existing vaccine is largely ineffective, and there is no simple test where most people first get care. Drug-resistant strains of the disease continue to spread, far outpacing the development of new drugs. And the treatment for drug-resistant TB can be grueling, with sometimes devastating side effects.
These challenges are real, but the biggest problem we face with tuberculosis is not scientific. It’s political.
TB has climbed up the list of major killers worldwide, but it’s stuck at the bottom of the list of political priorities.
Curing Hepatitis C, in an Experiment the Size of Egypt
A new approach tested in Egypt could become the blueprint for providing cutting-edge medicines to the poor.
"Once demonized for withholding lifesaving AIDS drugs from poor countries in Africa, chastened pharmaceutical companies are testing an alternative strategy: a complicated deal to sell hepatitis drugs at a fraction of their usual cost while imposing tight restrictions intended to protect lucrative markets in the West."
No sooner was the Ebola virus subdued in Africa than another virus, Zika, began sweeping through South and Central America. It has been linked to serious birth defects and is threatening to invade the United States. It is imperative that the World Health Organization not repeat its sluggish response to the Ebola crisis and act urgently this time to mobilize international action.
Until it reached the Western Hemisphere, the Zika virus — related to dengue, yellow fever and West Nile virus and named after the Ugandan forest where it was first identified almost 70 years ago — had caused little more than relatively mild, flulike infections. But in the nine months since it came to the Americas, it has moved swiftly through Brazil and two dozen other countries and territories, spread by mosquitoes of the Aedes species, which can breed in the tiniest pools of water and usually bite during the day, making them especially hard to control.
Though not particularly dangerous to the person infected, the spread of Zika has been accompanied by a huge spike in microcephaly, a congenital and irreversible deformation of the skull in newborn babies. The number of reported cases in Brazil jumped from 147 in 2014 to nearly 4,000 in 2015, leaving health officials with little doubt — although no firm scientific proof — that Zika was responsible. Scientists have also identified a possible link between the virus and the neurological disorder known as the Guillain-Barré syndrome.
At present there is no vaccine, no cure and no widely available test for Zika infection. In their absence, the obvious course is to avoid mosquito bites by wearing clothes that cover arms and legs, and using air-conditioning and screens and insect repellents containing DEET. Brazil, which is hosting the Olympic Games this summer, has begun an extensive campaign to eradicate mosquitoes, including the deployment of 220,000 soldiers to search for breeding sites, and has urged women to avoid getting pregnant until the outbreak is brought under control.
El Salvador has advised women to delay pregnancy until 2018. In the United States, the Centers for Disease Control and Prevention has issued a list of countries pregnant women would be wise to avoid and has urged pregnant women who have traveled to affected areas to see a doctor and determine whether a test is required. None of that is likely to quickly end the scourge, and no country can do that on its own. On the contrary, the virus could migrate to southern areas of the United States when winter ends.
Regrettably, despite these actions, the World Health Organization seems, once again, to be dozing and has yet to generate a broad and coordinated international response. By coincidence, the W.H.O. executive board is currently meeting in Geneva, so this is the perfect time for the agency to show leadership by convening an emergency committee of experts to take stock of the Zika pandemic and advise the W.H.O. director general, Dr. Margaret Chan, on how best to combat it.
Update: After publication, the World Health Organization announced Thursday it would convene an emergency meeting on Monday to decide whether to declare a public health emergency due to the spread of the Zika virus.
Q: My short-term memory has started to slip, and it feels pretty scary. When should I be worried?
I understand the feeling. I’ve looked for my phone while talking on it. We all do those kinds of things. But often, the root of the problem has more to do with attention and focus than an actual cognitive deficiency.
There are a lot of steps that go into making a memory. It’s a process. The first step is encoding. To do that properly, you have to take in all the relevant data about the concept you want to remember. This means focusing on the information you want to retain — like where you put your keys or parked your car. Once you have encoded something, you need to store it and be able to recall it.
Problems with these last two stages are associated with conditions like dementia. But for most younger people, the problem lies in the encoding. Doing too many things at once means we’re not able to give proper attention to any one task. For instance, if you come home and are thinking about dinner as you speak to your kids and sending a text at the same time, you likely won’t remember where you put your keys, because you weren’t focusing on the act of putting them down.
Young onset dementia (YOD) is rare and affects only about one person in every 1,000 — and most of these people are in their 50s and early 60s. (There are rare genetic forms of dementia that present in the 30s and 40s, but in these cases there is usually a strong family history.)
Related: Mike Byster’s tips to significantly improve your memory
When a patient expresses concern about memory, I always dig a little deeper. Poor memory may be a symptom of other physical or mental health issues, such as adult attention deficit disorder, sleep apnea, thyroid problems, vitamin B12 deficiency or difficulties related to perimenopause. And when associated with poor appetite, trouble sleeping and low mood, a concern about memory becomes a concern about depression.
There is cause for medical worry if you are consistently having trouble remembering things across several environments, or if difficulty with recall is impairing day-to-day life — if a patient tells me that she is consistently late for work, for instance, because she has to search her home from top to bottom to find things that she uses daily. But if you can remember things when you focus on them and are well rested, instances of forgetfulness should more likely be attributed to system overload.
Focusing on the task at hand will help with the encoding process. Routines, such as having a consistent place to put your keys, also help. And when you know you’re moving too quickly, stop and write down whatever it is you’ll need to recall later on.
Every day, nearly 1,000 young women around the world become infected with H.I.V., the virus that causes AIDS. More than half of the 37 million people worldwide infected with H.I.V. are women, and most of them live in sub-Saharan Africa. These women too often lack the awareness, the financial means and the power over their own lives to protect themselves from the virus. Tragically, more women of reproductive age around the world die from AIDS than from any other cause.
Now, women in the developing world have new hope. The results of two major studies in Africa that were released Monday show that a new device could help protect women against H.I.V. It is a flexible ring a woman inserts into her vagina, where it slowly releases an antiretroviral drug. In earlier studies in Africa, pills and gels that can prevent H.I.V. infection had high failure rates because women tended not to use them consistently. But the new ring is inexpensive, easy to insert, effective for one month and, once in place, undetectable by the woman or her male partner. It also has a shelf life of five years and requires no refrigeration — important advantages in the developing world.
The new ring is far from fail-safe, but it did reduce H.I.V. infection by 27 percent in one study and 31 percent in the other; both examined women ages 18 to 45. Researchers found the device was more effective for women over 21 than for younger women, most likely because the older women used the rings more consistently. But more research needs to be done to determine if there may be a biological reason that women under 21 showed little or no benefit. This is a major concern, because young women and teenage girls account for one in four new H.I.V. infections in Africa.
Research now moves to a ring that would be effective for three months and to one that would also release contraceptive drugs — a potential incentive to get young women to use the device consistently. That research cannot proceed fast enough.
Of course, new drugs and devices can only help so much. Poverty, a lack of education — 80 percent of young women in sub-Saharan Africa have not completed secondary school and a third cannot read — and social and cultural customs that keep women subordinate to their male partners, with little control over their sex lives, all contribute to women’s high infection rates. Investing in educating and empowering women in Africa and elsewhere in the developing world must remain an important part of the fight against this disease.
New Procedure Allows Kidney Transplants From Any Donor
In the anguishing wait for a new kidney, tens of thousands of patients on waiting lists may never find a match because their immune systems will reject almost any transplanted organ. Now, in a large national study that experts are calling revolutionary, researchers have found a way to get them the desperately needed procedure.
In the new study, published Wednesday in The New England Journal of Medicine, doctors successfully altered patients’ immune systems to allow them to accept kidneys from incompatible donors. Significantly more of those patients were still alive after eight years than patients who had remained on waiting lists or received a kidney transplanted from a deceased donor.
The method, known as desensitization, “has the potential to save many lives,” said Dr. Jeffery Berns, a kidney specialist at the University of Pennsylvania’s Perelman School of Medicine and the president of the National Kidney Foundation.
When Gene Tests for Breast Cancer Reveal Grim Data but No Guidance
At a time when genetic testing and genetically personalized treatments for cancer are proliferating, buoyed by new resources like President Obama’s $215 million personalized medicine initiative, women with breast cancer are facing a frustrating reality: The genetic data is there, but in many cases, doctors do not know what to do with it.
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