Prostate website helps men tailor treatment
Many patients 'heavily into denial'
The Canadian Press
Tuesday, September 19, 2006
Getting screened for possible prostate cancer or receiving a positive diagnosis can leave men perplexed and anxious about what their test results mean and their best options for further testing or treatment.
So the Prostate Cancer Research Foundation of Canada has come up with an interactive online program that it hopes will help men cut through all the extraneous information and misinformation and offer answers tailored to their individual cases.
Today, the foundation website (www.prostatecancer.ca) will begin providing a comprehensive collection of prostate cancer assessment tools, designed to give men the most accurate and up-to-date scientific data available to help them make informed treatment decisions with their doctors.
"We think that overall men are heavily into denial and refuse to ask certain questions, refuse to go and get tested," foundation president John Blanchard said in an interview Monday. "We think if we can put together some easily understood ways that they can privately assess where they're at, it will open their eyes."
This year, an estimated 20,700 Canadian men will be diagnosed with prostate cancer and about 4,200 will die from the disease.
Although the medical establishment maintains a fanatical adherence to drugs and surgery as the only respectable way to treat illness, nevertheless researach supporting the common sense wisdom of the body's of common sense can still be found.
1. Vegetarianism is good for you. There are two reasons for this. First, avoiding meat is a way to keep your weight down. Second, you have to eat a lot of vegetables to get enough calories per day, and this increases your intake of vitamins and minerals.
2. Stress reduction works. The best studies of heart disease and cancer indicate that high stress is harmful. Stress reduction brings the body back into balance generally, which is itself a good thing. It reduces high blood pressure, although it isn't a cure. Meditation is a proven stress reducer.
3. Small amounts of exercise are absolutely necessary. A completely sedentary life is a major cause of overweight ad higher risk of many diseases. An adequate amount of exercise would include regular housecleaning, walking on a daily basis, taking care of a small child, climbing the stairs instead of taking the elevator, etc. As far a weight loss goes, it's been shown that walking a mile loses more weight than jogging a mile, and jogging loses more than running. This is because heavier exercise is anaerobic (doesn't use oxygen) and causes the body to preserve calories rather than shed them.
4. Fresh pure food is best. Even though organic food has not been proven to be a major factor in good health, it still makes perfect sense to opt for the least contaminated food you can. The general public is right to be suspicious of chemical preservatives in goods, and processed food tends to have too many calories in proportion to vitamins and minerals. Life span is steadily increasing, with the decrease in the incidence of heart disease and strokes, but the worldwide intake of processed and junk food is promoting gross obesity and type 2 diabetes.
5. Staying away from the doctor is good for you. The medical establishment gave up on the old recommendation that everyone get a six-month checkup because it wasn't working. About 90% of serious illness is first detected by the patient. Secondly, people who live to great old age tend to not see doctors and to avoid taking drugs. It's not healthy to rely on drugs, to haunt the doctor's office, or to worry over minor illness and discomforts.
6. Moderation is the best preventive. It sounds banal, but doing a bit of what's good for you is the best medicine, while too much of a good thing is bad. Eat when you are hungry, stop eating when you aren't hungry. Omega 3 fish oil is good for thinning the blood, but too much runs the risk of stroke. Red wine is good for you, too much is bad for the liver. Eating your vegetables is good for you, trying to live on megavitamins probably isn't. For lacto-tolerant individuals, organic milk remains a healthy food.(men who drink a quart of milk a day seem to reduce their risk of heart attack, for example). Making sure you exercise into old age is good, but over-exercise at younger ages can lead to joint problems later on. Finally, natural exercise like jogging outside does more good to more muscle groups than running on a treadmill. Using gym equipment is fine, but being outside in the sunshine is better.
None of this sounds revolutionary, but there is an underlying wisdom at work. Your body knows what it is doing, and if you listen to it and cooperate sensibly, good health is the norm, not the exception. We are a society with incredible advantages in terms of health, and the sooner we stop relying only on outside authorities, and begin to rely more on the wisdom of our bodies, the better.
Cell transplant can help diabetics be injection-free
The Canadian Press
Thursday, September 28, 2006
Transplanting insulin-producing pancreatic cells into patients with Type 1 diabetes can dramatically improve control of fluctuating blood sugar levels and has even allowed some diabetics to go off daily injections, a Canadian-led international study has found.
The landmark study, led by transplant surgeon Dr. James Shapiro of the University of Alberta, involved 36 adult diabetics at nine centres in Canada, the United States and Europe -- the first multicentre trial to test the effects of transplanting insulin-secreting islet cells into different populations using what's been dubbed the "Edmonton protocol."
The 36 participants, who ranged in age from 23 to 59 and had lived with Type 1 diabetes for many years, each received between one and three infusions of islet cells taken from deceased organ donors.
The patients take new-generation immune-suppression drugs to prevent rejection of the islets.
A year after the final treatment, 16 of the recipients (44 per cent) no longer needed insulin injections, and another 10 (28 per cent) had partial islet function, say the authors, whose report is published in today's issue of the New England Journal of Medicine.
Overall, transplanted islet cells continued to make insulin in more than 70 per cent of cases, Shapiro said from Edmonton, although he noted that there was some fall-off in insulin production, so most patients had to begin topping up levels of the hormone with small injections.
"But the remarkable finding of this paper is that once you restore insulin secretion in these patients, even if it's not enough to keep some completely free of insulin (injections), these patients are completely protected against hypoglycemia, and that was the primary indication for the transplant in the first place."
Type 1 diabetes is a disease that causes the body's immune system to go awry and turn its wrath on healthy insulin-secreting cells in the pancreas, known as islets of Langerhan. As a result, diabetics have no insulin to control blood sugar. If blood sugar is chronically high, diabetics are at risk for blindness, kidney failure and nerve damage that can lead to limb amputation. When blood sugar falls too low -- a condition known as hypoglycemia -- it can lead to periodic loss of consciousness, or diabetic coma.
Adults and teenagers who have not received booster shots against whooping cough (pertussis) are putting newborn babies at risk of contracting the nasty disease, which can be fatal in children under one year of age, experts say.
Studies being presented at a major infectious diseases conference in Toronto show cases of whooping cough are on the rise, despite a new vaccine that can boost the waning immunity of teens and adults and ensure they don't bring the bug home to baby.
"We've got something that can potentially make a dent in this disease, which is continually plaguing the kids, resurfacing every couple of years as an epidemic," infectious diseases expert Dr. Jeffrey Duchin said of the new vaccine, designed as a booster for adolescents and adults.
"A lot of people don't realize it's out there."
Dr. Irini Daskalaki, a clinician and researcher at St. Christopher's Hospital for Children in Philadelphia, said it is clear how rates of infection and deaths in young children can be reduced.
"Everyone should receive a booster. This booster will help decrease the burden of disease and with less whooping cough around, the young infants would have less possibility to be exposed," said Daskalaki, a co-author of another of the pertussis studies presented at the annual meeting of the Infectious Diseases Society of America.
Pertussis is a highly contagious bacterial disease that causes a persistent and debilitating cough that can linger for weeks in adults.
It gets its street name from the "whooping" sound heard when a person tries to catch a breath in the midst of a characteristically severe coughing fit.
It's an unpleasant disease in adults. Frequent and harsh coughing bouts can lead to ruptured blood vessels in the face or the eye, cracked ribs, herniated discs and punctured lungs.
But it's even harder on babies, who often end up hospitalized and may see a doctor two or three times before the illness resolves. It is estimated that one in 200 children who catch pertussis in the first year of life will die from the infection.
One study presented at the conference showed that in 160 cases of infant pertussis in San Francisco, 77 per cent were hospitalized and 14 per cent developed pneumonia. One baby died.
The disease used to be rampant, before a vaccine was developed in the 1940s. Rates dropped dramatically once it was in wide use.
But the vaccine's protection wears off as children reach adolescence. And with new people to infect, the disease follows a wax-and-wane cycle that can be avoided, Duchin said.
"The idea behind the new vaccine is: Stop the cycling. Get it at a low level, let's keep it at a low level. Keep adults and older kids from getting pertussis and transmitting it to the young ones."
The study he and his colleagues in the public health department of Seattle, Wash., presented showed that in 62 per cent of pertussis cases involving an infant, an older household member was probably the source of the infection.
October 30, 2006
A Lung Cancer Breakthrough?
The use of annual CT scans to screen for lung cancer is either an enormous breakthrough that holds the first real promise for curing this normally lethal disease — or an unproven tool whose real value is yet to be determined. Those are the possibilities raised by a multinational study led by researchers at NewYork-Presbyterian Hospital/Weill Cornell Medical College.
The new study, published last week in The New England Journal of Medicine, derives strength and credibility from its large size. The researchers administered CT scans to more than 31,000 people in seven countries who were deemed at high risk of lung cancer.
None of the participants had any symptoms, like a persistent cough, shortness of breath or chest pains. Yet the CT scans picked up hundreds of suspicious lumps and led to a diagnosis of lung cancer in 484 participants. Most of the tumors were caught at a very early stage, when they are most curable. The vast majority were removed.
The results seem, on the face of it, remarkably promising. Lung cancer ordinarily kills 95 percent of its victims, and only 15 percent live for even five years after they receive their diagnosis. But in the new study, the researchers projected that 80 percent would live for at least 10 years. Of those who had early stage tumors that were removed within a month of detection, an astonishing 92 percent are expected to survive for 10 years.
Some cancer experts and advocates for lung cancer patients are hailing the dawn of a new era in which lung cancer will move from a disease that is usually fatal to one that is usually curable. So why do many experts have misgivings about recommending widespread CT scan screening?
The main problem with this study is that it did not include a control group of people who were not screened with CT scans, so there is no definitive way to be sure that those who were screened will live any longer than a group that wasn’t screened. It is possible that the CT scans are detecting tiny lumps that would never have killed anyone or that removing tiny tumors early does not really lead to a longer life than removing the same tumors later. CT scans also can lead doctors to perform needless biopsies that involve sticking needles into the lungs, followed perhaps by needless surgery to remove tumors that might never have become a problem.
Most governmental and medical organizations that issue advice on cancer screening are expected to wait several years for the results of more definitive studies before recommending CT scans for lung cancer. Meanwhile, smokers and others at high risk will need to consult their doctors on the potential risks and benefits of getting a CT scan every year.
November 22, 2006
Study Questions Need to Operate on Disk Injuries
By GINA KOLATA
People with ruptured disks in their lower backs usually recover whether or not they have surgery, researchers are reporting today. The study, a large trial, found that surgery appeared to relieve pain more quickly but that most people recovered eventually and that there was no harm in waiting.
And that, surgeons said, is likely to change medical practice.
The study, published in The Journal of the American Medical Association, is the only large and well-designed trial to compare surgery for sciatica with waiting.
The study was controversial from the start, with many surgeons saying they knew that the operation worked and that it would be unethical for their patients to participate in such a study.
In the end, though, neither waiting nor surgery was a clear winner, and most patients could safely decide what to do based on personal preference and level of pain. Although many patients did not stay with their assigned treatment, most fared well with whatever treatment they had.
Patients who had surgery often reported immediate relief. But by three to six months, patients in both groups reported marked improvement.
After two years, about 70 percent of the patients in the two groups said they had a “major improvement” in their symptoms. No one who waited had serious consequences, and no one who had surgery had a disastrous result.
Many surgeons had long feared that waiting would cause severe harm, but those fears were proved unfounded.
“I think this will have an impact,” said Dr. Steven R. Garfin, chairman of the department of orthopedic surgery at the University of California, San Diego. “It says you don’t have to rush in for surgery. Time is usually your ally, not your enemy,” Dr. Garfin added.
As many as a million Americans suffer from sciatica, said Dr. James Weinstein, a professor of orthopedic surgery at Dartmouth who led the study. The condition is characterized by an often agonizing pain in the buttocks or leg or weakness in a leg.
It is caused when a ruptured disk impinges on the root of the sciatic nerve, which runs down the back of the leg. And an estimated 300,000 Americans a year have surgery to relieve the symptoms, Dr. Weinstein said.
Patients are often told that if they delay surgery they may risk permanent nerve damage, perhaps a weakened leg or even losing bowel or bladder control. But nothing like that occurred in the two-year study comparing surgery with waiting in nearly 2,000 patients.
The study did not include people who had just lower back pain, which can have a variety of causes. Nor did it include people with conditions that would require immediate surgery like losing bowel or bladder control.
Instead, they were typical of a vast majority of people with sciatica who are made miserable by searing pain. For such patients, fear that delaying an operation could be dangerous “was the 800-pound gorilla in the room,” said Dr. Eugene J. Carragee, professor of orthopedic surgery at Stanford.
Dr. Carragee said that he had never believed it himself, but that the concern was widespread among patients and doctors.
“The worry was not knowing,” he added. “If someone had a big herniated disk, can you just say, ‘Well, if it’s not bothering you that much, you can wait?’ It’s kind of like walking on eggshells. What if something terrible did happen?”
With the new results, it is clear that the risk of waiting “is, if not extraordinarily small, at least off the radar screen,” Dr. Carragee said.
The study involved 13 spine clinics in 11 states. All the participants had pain from herniated disks and leg pain. The patients were asked whether they would allow the researchers to decide their treatment at random. Those who did not have surgery generally received physical therapy, counseling and anti-inflammatory drugs.
In the end, the study could not provide definitive results on the best course of treatment because so many patients chose not to have the treatment that they had been randomly assigned.
About 40 percent of those assigned to surgery decided not to have it, often because their conditions improved while they awaited the operations. A third of patients assigned to wait decided to have operations, often because their pain was so bad that they could not endure it any longer.
Others asked not to be assigned at random and were followed to see what treatment they chose and how they fared.
The researchers are also conducting a separate analysis on the cost effectiveness of surgery compared with waiting. Although that analysis has not been published, Dr. Anna N. A. Tosteson of Dartmouth, an author of the study, said that Medicare paid a total of $5,425 for the operation and that private insurers might pay three to four times that.
Although the results answered one question, about the safety of waiting, they were also, in a sense, disappointing, said Dr. David R. Flum, a contributing editor at The Journal of the American Medical Association and an associate professor of surgery at the University of Washington.
“Everyone was hoping the study would show which was better,” Dr. Flum said.
“And everyone was surprised by the tremendous number of crossovers in both directions,” he added, referring to the large number of participants who changed from surgery to waiting and vice versa.
That muddied the data.
Sciatica tends to run in families and occurs when the soft gel-like material inside a spinal disk protrudes through the outer lining of the disk like a bubble on a bicycle tire. That compresses and inflames a nerve root that forms the sciatic nerve.
The resulting pain can feel like a burning fork in the buttocks, Dr. Weinstein said. Or it can be a searing pain down the back of a leg. The pain can be so intense that some people cannot walk. Some cannot sit. Some, Dr. Weinstein said, “can barely crawl.”
The operation is quick and generally effective, Dr. Garfin said. It involves gently pushing the compressed nerve root away from the herniated disk. Then the surgeon makes an incision in the disk and deflates it. The nerve returns to its normal position, the inflammation goes away, and the pain often disappears.
The Journal of the American Medical Association published two papers on the study, one reporting on the randomized trial and the other on the patients who chose not to be randomized. It also published editorials by Dr. Carragee and Dr. Flum.
The reason for all the attention, Dr. Flum explained, was that the study was large and well designed, that its authors had no conflicts of interest, and, “We can learn a lot.”
The message, in the end, Dr. Weinstein said, was that no matter which treatment a patient received, “nobody got worse.”
He added, “We never knew that until we did the study.”
Millions of chest pain and heart attack sufferers thought they were getting a phenomenal medical advance when tiny coils that ooze medicine were placed in their arteries to keep them from squeezing shut again.
These gizmos, called drug-coated stents, worked so much better than plain old metal ones that six million people worldwide received them in the few years they have been available. It was a modern record for any medical device.
Now their long-term safety is in question.
Doctors think these stents may raise the risk of life-threatening blood clots months and even years later unless people stay on Plavix, an anti-clotting drug whose long-term safety in stent patients has not been established.
Thousands of people are being urged to take the $4-a-day drug until more is known.
Thousands of others each day who develop new blockages are being treated by doctors no longer sure of what to do. Many are returning to the old metal stents, and some are fundamentally rethinking when to use stents at all and are considering alternatives such as bypass surgery or medications.
Doctors also worry about overreacting to a risk that appears small -- five or fewer clots in every 1,000 patients.
"The benefit of having a drug-eluting stent is tremendous," said Dr. Elizabeth Nabel, director of the National Heart, Lung and Blood Institute.
Stents are used in angioplasty. Through a blood vessel in the groin, doctors push a tube to a blocked heart artery, inflate a balloon to flatten the clog, and prop the artery open with a stent.
About 652,000 Americans had angioplasty in 2003 -- more than twice the 268,000 who had bypass operations, which are riskier, costlier and take far longer to heal. Angioplasty became more popular when the first drug-coated stent came out that year, virtually eliminating the procedure's main drawback: scar tissue requiring a repeat effort to reopen the vessel.
Two brands are sold in the United States -- Taxus, by Boston Scientific Corp., and Cypher, by Johnson & Johnson's Cordis Corp. Labels say patients should take baby aspirin and Plavix for three months with Cypher and six months with Taxus, based on how long the stents release medication and how long doctors believed it took for the artery to repair itself by forming a new lining. Many doctors prescribe Plavix for up to a year.
Now it seems the coated stents may keep this essential artery lining from forming for a long time, maybe permanently. Without the lining or Plavix, clots can form and stick to stents.
Cholesterol a possible cause of diabetes
Artery-clogging fat may impact insulin cells
The Canadian Press
Monday, February 19, 2007
Cholesterol may not just be bad for your heart.
A study suggests problems with cholesterol regulation in the insulin-producing cells of the pancreas may be responsible for the development of Type 2 (formerly known as late onset) diabetes.
The work, by scientists at Vancouver's Child and Family Research Institute, was done in mice. And the researchers would have to show that the same mechanism is seen in people.
But if their theory is correct, it could open new avenues for the prevention and control of Type 2 diabetes, a condition the Canadian Diabetes Association estimates affects more than 1.8 million Canadians and rising.
"This is an important observation because it demonstrates a new potential mechanism by which in Type 2 diabetes the beta cells could be dysfunctional," said Dr. Bernard Zinman, a diabetes expert who was not involved in the study.
The article was published online Sunday by the journal Nature Medicine.
The Vancouver research started in the laboratory of Dr. Michael Hayden, director of the institute's centre for molecular medicine and therapeutics.
Hayden is an expert in the genes involved in cholesterol metabolism. That work led to the cloning of a gene called ABCA1 that was shown to play a key role in regulating the amount of cholesterol in the blood.
Hayden's lab has focused on cholesterol and its role in heart disease. But the thesis of one of his graduate students, Dr. Liam Brunham, raised the issue that cholesterol is found in the beta cells -- the cells responsible for insulin production -- of the pancreas.
"We were perplexed by that, because why is it even in the pancreas and why is it so highly expressed (produced)?" Hayden recalled in an interview.
They consulted Dr. Bruce Verchere, a beta cell expert who heads the institute's diabetes research program. The group decided to see what would happen if they genetically engineered mice to knock out the ABCA1 gene.
The answer was clear.
"The animals developed diabetes. And furthermore, the animals showed a . . . very significant accumulation of cholesterol in the beta cells," Hayden said.
Verchere said all cells, including the beta cells, need some cholesterol, but levels need to be "tightly regulated."
"It has to be there in the right amounts," he said from Vancouver.
"If you can't regulate it and there's too much of it, it's almost like too much of a good thing. That's when the beta cell goes awry."
To the group's knowledge, this is the first paper questioning whether cholesterol dysfunction is responsible for the inability of the beta cells to properly secrete the insulin the body needs to metabolize foods. For Zinman, too, it was a novel idea.
"Now whether it has any relationship to people is unclear of course. No one has described this kind of abnormality in people that I'm aware of," said Zinman, director of the Leadership Sinai Centre for Diabetes at Toronto's Mount Sinai Hospital.
He noted, though, that there are competing theories. One is that amylin, a hormone produced by the beta cells, builds up to excess amounts and knocks out the beta cells' ability to function properly.
Zinman suggested it's also possible that the overproduction amylin and cholesterol may be the result of some yet unidentified problem that is behind the development of Type 2 diabetes.
Hayden said the group is pursuing other studies that should indicate by year's end whether the cholesterol regulation problems are seen in humans with Type 2 diabetes.
Much attention has been focused on the cardiovascular risks posed by Vioxx and other so-called cox-2 inhibitors in recent years, so the American Heart Association provided an important service this week by reminding us that many other painkillers have risks associated with them. The association spelled out gradations of cardiovascular risk and recommended a step-by-step approach — starting with nonmedicinal remedies — that doctors should follow when treating joint and ligament pain.
The scientific statement applies specifically to patients who already have or are at risk of heart disease and also need relief from pain — whether caused by short-term sprains or long-term rheumatoid arthritis. But the lead author believes that everyone might benefit from the same cautious approach toward pain relief.
A lot has happened since the heart association issued a similar advisory two years ago. The evidence has gotten even stronger that the cox-2 inhibitors — Celebrex is the only one left on the market in this country — increase the risk of heart attacks and strokes. And new evidence has emerged that some other painkillers also increase the cardiovascular risks.
The most striking recommendation is that pain treatments should start with nonmedicinal approaches, like physical therapy and exercise, weight loss to reduce stress on joints, and hot or cold packs. Only if those don’t provide enough relief should drugs be used, and the doctor should take a step-by-step approach in prescribing medications, from the safest to the riskiest.
The first medication would usually be acetaminophen or aspirin at the lowest effective dose, or certain other low-risk drugs. Only if those fail should doctors progress to riskier drugs, starting with naproxen and then perhaps ibuprofen, both available over the counter. A cox-2 inhibitor should be prescribed only as a last resort. The overall message is that one should use the lowest effective dose of the safest drug for the shortest period of time. That is always good advice, but it tends to be forgotten in an age when drugs are so heavily promoted.
Egypt's 'Dr. Ruth': Let's talk sex in the Arab world
POSTED: 1550 GMT (2350 HKT), April 26, 2007
• Dr. Heba Kotb tackles the taboo of Arab world: She talks sex openly
• Her advice to married couples is to have more sex -- "Don't be
• Kotb has gained in popularity so much she's booked three months out
• Men, women on streets of Cairo are reluctant to talk on the
By Aneesh Raman
Adjust font size:
CAIRO, Egypt (CNN) -- Dr. Heba Kotb is tackling a taboo in the Arab
world unlike anyone else: She's talking about sex openly on a show
broadcast all over the Middle East.
It's a big first in these parts of the world, and Kotb leaves little
"We talk about masturbation ... sex over the Internet. We talk about
sex and Ramadan. We talk about the wedding night," said Kotb.
Entitled "The Big Talk," the show is broadcast once a week over a
satellite channel from Cairo, Egypt.
It took the 39-year-old mother three years of negotiations to get
her show on the air. And a main reason she succeeded is that she
talks only about sex allowed in the Quran -- sex between husband and
wife. (Watch sexologist describe why sex is good )
But even with that guideline, it's no easy sell.
The promo for "The Big Talk" starts with Kotb saying, "Sex. Don't be
afraid. Join me to talk about sex without shame."
And people are doing just that. The show is gaining in popularity
throughout the Middle East. So much so that Kotb just signed with a
new production company and plans to push the sexual envelope even
further in her discussions.
For the moment her main advice for married couples: Have more sex.
"You have nowhere else to get your sexuality but from your spouse.
It's the only source available, so it's very important."
And for the men she has some blunt advice: "You have to have
foreplay with your wife and you have to have sex with her
frequently, not just when you want to."
Surgical dreams to sexologist
Growing up, Kotb desperately wanted to be a surgeon. But years
later, when she started a family after medical school and wanted
more time with her daughters, she decided to change paths.
"Leaving surgery felt like falling from a very high point to a low
point. I thought, 'Oh my God, I'm going to end up just doing
something less exciting.' I wanted to be productive."
It was while making that decision, that Kotb was writing a
dissertation on sexual assaults. For the study, she needed to
discuss normal sexual behavior and suddenly realized she had no idea
where to start.
"I thought, 'Oh my God, me -- a medical doctor who has a masters; is
working on a Ph.D. -- doesn't know anything about this.' How did all
these people I was reading know about sexuality?"
So she started researching while wondering why her part of the world
was so averse to talking about sex. It was something Kotb wanted to
change and she found a way in the Quran: a passage that discusses
sex between husband and wife.
The passage reads: "Your wives are as a tilth [land or soil to be
cultivated] unto you; so approach your tilth when or how ye will;
but do some good act for your souls beforehand; and fear Allah."
That verse, she says, makes it known that sex shouldn't just happen
when the husband wants but that the wives have rights too.
"I was so proud of my religion when I saw that. My religion was
advanced enough to talk about women's rights in sexuality how many
years before modern science did?"
From that moment, there was no turning back.
First come patients, then the show
Kotb got her first degree in clinical sexology in 2003. A year
later, she earned her doctorate in human sexuality, clinical
sexology and pastoral counseling from Maimonides University in
All the while, her family showed steadfast support. Her father
helped her to pay for her doctoral degree, while her husband kept
pushing her to do what she loved.
And shortly after getting her degrees, she did, opening a clinic in
downtown Cairo. In the beginning, things were rough.
"It was a mess," she said. "I had one or two patients per week."
But five years later, things have certainly changed. Now, Kotb's
calendar is booked three months in advance. She says patients are
much more open about sex and the specifics they talk about in her
She expanded her work to include television, launching "The Big
Talk" several months ago. The show is, by all accounts popular,
although you wouldn't know it from walking Cairo's streets.
In the middle of downtown, women refused to discuss the show when
asked about it.
It was an expected sign of just how sensitive the topic of sex is in
the Muslim world. And even though the men were more willing to talk
about it, they were less than enthusiastic about the subject.
In fact, Kotb has critics on all sides. Those more liberal think
she's not being open enough about sex, ignoring topics like extra
marital affairs, homosexuality and pregnancy out of wedlock.
Meanwhile, conservatives think sex is not for public discussion.
"There is no reason to talk about sex on television. Our society
doesn't need something like this," a shopkeeper named Fawi said.
For her part, Kotb has no plans to slow down.
"I wanted to be the first sexologist in the Arab World not because
of the challenge of being first," she said. "That didn't cross my
mind. I did it because I was interested in the subject and I wanted
to help people."
And she has no regrets.
"A mother of a friend of mine, when she first knew I was doing this
career five years ago, she looked at me and said, 'Oh my God, are
you teaching people to sleep with each other?'"
"I said 'yes,'" Kotb responded with a laugh. "That's what I do. This
is the truth. And I'm very proud of this."
Step away from the mop. A report published in the May issue of the journal Allergy has confirmed what scientists have long suspected, and amateur housekeepers always hoped: dirt and dust can be good things.
According to the University of Cincinnati study, early life exposure to indoor fungal molecules -- the kind commonly found in carpets and on floors -- can build stronger immune systems and protect against the development of allergies. In other words, postponing "spring cleaning" may be as good for your baby's long-term physical health as it is for your short-term mental health.
"If you keep your house too clean, you don't provide the microbial components to stimulate the immune system," explains Yulia Iossifova, lead author of the Allergy paper.
In a study group of 574 infants identified as having a risk for future allergies, health scientists found that babes exposed to high levels of "fungal glucans" and "bacterial endotoxins" in their primary activity rooms were nearly three times less likely to wheeze than those accustomed to more sanitized environments.
The epidemiological study, funded by the National Institute of Environmental Health Sciences, is the first to make the link between early life mould exposure and stronger immune systems.
Unfortunately, the positive effects only apply to the Teletubbies set.
"Whether you'll be susceptible to allergies later in life depends on immune development during pregnancy and then in the first three to four years of your life," says Iossifova. "If people haven't been exposed to microbial components as little children, being exposed to them as adults makes them develop allergies very easily."
Sharon Moalem, a Canadian neurogeneticist and researcher at Mount Sinai School of Medicine, says the findings suggest parents who are trigger-happy with antibacterial sprays are doing their kids more harm than good.
"You don't want your kid licking the floor in Grand Central Station," says Moalem, who investigates the evolutionary component to illness in his book Survival of the Sickest. "But, most parents today are definitely going overboard as far as maintaining a sterile environment."
The current mania for cleanliness has driven consumers to invest in everything from home air purifiers to hand sanitizers and antibacterial gloves. And though some 600 micro-organisms, bacteria, fungi and viruses are genuinely dangerous to humans -- including salmonella and E. coli -- scientists are constantly discovering "germs" that are beneficial.
"This goes with the dictum that whatever doesn't kill you makes you stronger," says Moalem.
June 13, 2007
Symptoms Found for Early Check on Ovary Cancer
By DENISE GRADY
Cancer experts have identified a set of health problems that may be symptoms of ovarian cancer, and they are urging women who have the symptoms for more than a few weeks to see their doctors.
The new advice is the first official recognition that ovarian cancer, long believed to give no warning until it was far advanced, does cause symptoms at earlier stages in many women.
The symptoms to watch out for are bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly and feeling a frequent or urgent need to urinate. A woman who has any of those problems nearly every day for more than two or three weeks is advised to see a gynecologist, especially if the symptoms are new and quite different from her usual state of health.
Doctors say they hope that the recommendations will make patients and doctors aware of early symptoms, lead to earlier diagnosis and, perhaps, save lives, or at least prolong survival.
But it is too soon to tell whether the new measures will work or whether they will lead to a flood of diagnostic tests or even unnecessary operations.
Cancer experts say it is worth trying a more aggressive approach to finding ovarian cancer early. The disease is among the deadlier types of cancer, because most cases are diagnosed late, after the cancer has begun to spread.
This year, 22,430 new cases and 15,280 deaths are expected in the United States.
If the cancer is found and surgically removed early, before it spreads outside the ovary, 93 percent of patients are still alive five years later. Only 19 percent of cases are found that early, and 45 percent of all women with the disease survive at least five years after the diagnosis.
By contrast, among women with breast cancer, 89 percent survive five years or more.
The new recommendations, expected to be formally announced on June 25, are being made by the Gynecologic Cancer Foundation, the Society of Gynecologic Oncologists and the American Cancer Society.
More than 12 other groups have endorsed them, including CancerCare; Gilda’s Club, a support network for anyone touched by cancer; and several medical societies.
“The majority of the time this won’t be ovarian cancer, but it’s just something that should be considered,” said Dr. Barbara Goff, the director of gynecologic oncology at the University of Washington in Seattle and an author of several studies that helped identify the relevant symptoms.
In a number of studies by Dr. Goff and other researchers, these symptoms stood out in women with ovarian cancer as compared with other women.
“We don’t want to scare people, but we also want to arm people with the appropriate information,” said Dr. Goff, who is also a spokeswoman for the Gynecologic Cancer Foundation.
She emphasized that relatively new and persistent problems were the most important ones. So, the transient bloating that often accompanies menstrual periods would not qualify, nor would a lifelong history of indigestion.
Dr. Goff also acknowledged that the urinary problems on the list were classic symptoms of bladder infections, which is common in women. But it still makes sense to consult a doctor, she said, because bladder infections should be treated. Urinary trouble that persists despite treatment is a particular cause for concern, she said.
With ovarian cancer, even a few months’ delay in making the diagnosis may make a difference in survival, because the tumors can grow and spread quickly through the abdomen to the intestines, liver, diaphragm and other organs, Dr. Goff said.
“If you let it go for three months, you can wind up with disease everywhere,” she said
Dr. Thomas J. Herzog, director of gynecologic oncology at the Columbia University Medical Center, said the recommendations were important because the medical profession had until now told women that there were no specific early symptoms.
“If women were more pro-active at recognizing these symptoms, we’d be better at making the diagnosis at an earlier stage,” Dr. Herzog said.
“These are nonspecific symptoms that many people have,” he added. “But when the symptoms persist or worsen, you need to see a specialist. By no means do we want this to result in unnecessary surgery. But I would not expect that to occur in the vast majority of cases.”
Although the American Cancer Society agreed to the recommendations, it did so with some reservations, said Debbie Saslow, director of breast and gynecologic cancer at the society.
“We don’t have any consensus about what doctors should do once the women come to them,” Dr. Saslow said. “There was a lot of hope that we’d be able to say, ‘Go to your doctor, and they will give you this standardized work-up.’ But we can’t do that.”
At the same time, Dr. Saslow said, the cancer society recognized that in some cases doctors had disregarded symptoms in women who were later found to have ovarian cancer, telling the women instead that they were just growing old or going through menopause.
“There are so many horror stories of doctors who have told women to ignore these symptoms or have even belittled them on top of that,” Dr. Saslow said.
In a survey of 1,700 women with ovarian cancer, Dr. Goff and other researchers found that 36 percent had initially been given a wrong diagnosis, with conditions like depression or irritable bowel syndrome.
“Twelve percent were told there was nothing wrong with them, and it was all in their heads,” Dr. Goff said.
Dr. Goff and other specialists said women with the listed symptoms should see a gynecologist for a pelvic and rectal examination. (The best way for a doctor to feel the ovaries is through the rectum.) If there is a question of cancer, the next step is probably a test called a transvaginal ultrasound to check the ovaries for abnormal growths, enlargement or telltale pockets of fluid that can signal cancer. The ultrasound costs $150 to $300 and can be performed in a doctor’s office or a radiology center. A $100 blood test should also be conducted for CA125, a substance called a tumor marker that is often elevated in women with ovarian cancer.
Cancer specialists say any woman with suspicious findings on the tests should be referred to a gynecologic oncologist, a surgeon who specializes in cancers of the female reproductive system.
An unresolved question is what exactly should be done if the test results are normal and yet the woman continues to have symptoms, Dr. Saslow said.
“Do you do exploratory surgery, which has side effects, which are sometimes even fatal?” she asked. “What do you do? We don’t have the answer to that.”
Depending on the test results, the woman may just be monitored for a while or advised to undergo a CT scan or an MRI. But if cancer is strongly suspected, she will probably be urged to go straight to surgery. A needle biopsy, commonly used for breast lumps, cannot be safely performed to check for ovarian cancer because it runs a risk of rupturing the tumor and spreading malignant cells in the abdomen. Instead, the surgeon must carefully remove the entire ovary or the abnormal growth on it and examine the rest of the abdomen for cancer.
While the patient is still on the operating table, biopsies are performed on the tissue that was removed, so that if cancer is found, the surgeon can operate more extensively. Experts say such an operation should be carried out just by gynecologic oncologists, who have special training in meticulously removing as much of the cancerous tissue as possible. This procedure, called debulking, lets chemotherapy work better and greatly improves survival.
Dr. Carol L. Brown, a gynecologic oncologist at the Memorial Sloan Kettering Cancer Center in Manhattan, said, “Ideally, we need to develop a screening tool or a test to find ovarian cancer before it has symptoms.”
No such screening test exists, Dr. Brown said, and until one is developed, the list of symptoms may be the best solution.
“This is something that women themselves can do,” she added, “and we can familiarize clinicians with, to help make the diagnosis earlier.”
Value of breast self-exams questioned by cancer society
CanWest News Service
Thursday, September 27, 2007
Teaching women to do monthly breast self-exams for cancer isn't quite the lifesaver it's been touted to be.
After years of telling women to examine their breasts on the same day every month and even providing detailed diagrams of how to do it, the Canadian Cancer Society is tossing monthly breast self-exams off its list of recommended practices, saying they are a very poor way to detect cancer.
This about-face in policy came from the society Wednesday as it announced that from now on, women should be more aware of the state of their breasts, not just on a monthly basis, and that clinical examinations and mammograms are the only ways to detect this deadly disease in the crucial early stages.
Circle the same day on the calendar, lift one arm at a time and move your fingertips in a circular motion over your breast and underarm. Almost every woman has been given these instructions, sometimes even on waterproof cards to hang in the shower as a reminder.
No more. The Cancer Society says the technique may have given women a false sense of security that kept them from having mammograms or a clinical exam by a professional health care worker.
"Even though we will no longer be recommending breast self-exams as a monitoring method, it is still important for women to look at and feel their breasts to detect any changes in them. The new message is that they don't need a specific technique or schedule to do so," said Suzanne Dubois, executive director of the Canadian Cancer Society in Quebec.
But David Fleiszer, a McGill University Hospital Centre specialist in breast diseases, is skeptical about throwing out breast self-exams in a fight against cancer where early diagnosis is the key to winning the race.
"If their (the Cancer Society's) point is to emphasize that mammograms are key, then yes, I agree, but to just say that mammograms are better than (breast self-exams), so don't bother to do (breast self-exams) makes no sense to me," Fleiszer said.
The Canadian Cancer Society says women should watch for the following changes in their breasts and consult their physicians if they notice:
Leading cancer organizations reported last week that mortality rates dropped an average of 2.1 percent a year between 2002 and 2004, almost double the average annual decrease from 1993 to 2002. That is a stunning reversal of the relentless increase in cancer death rates seen in the decades before the 1990s. The turnaround appears to be mainly a triumph in prevention and early detection rather than dazzling medical cures.
The main factor in the accelerated decline was a drop in the death rate from colorectal cancer in men and women, mostly attributable to more widespread colonoscopy screening. The report also noted longer-term declines in the death rates from lung cancer in men, mostly because of reduced smoking; prostate cancer in men, for reasons that are unclear; and breast cancer in women, attributable to screening mammography and a large-scale exodus of women from the use of hormone replacement therapy.
There is clearly room for improvement. Only about half of American adults over 50 have been screened for colorectal cancer, far less than the percentage of women screened for cervical and breast cancer. Welcome as these gains may be, they pale in comparison with the remarkable turnaround in cardiovascular disease. By 2004, the death rate from coronary heart disease was 66 percent lower than in 1950, and the death rate from strokes was 72 percent lower. These gains have been attributed to impressive therapeutic advances and to lifestyle changes.
Although there have been improvements in treating cancer, only a minority of patients can be treated effectively once cancer has spread from its original site to distant points in the body. For now, the best hope lies in prevention and early detection.
Prostate cancer deaths tied to obesity in men
Those of healthy weight more likely to survive
CanWest News Service
Monday, November 12, 2007
Obese men diagnosed with prostate cancer are twice as likely as healthy weight men to die from the disease, new research shows.
The heavier a man is at time of diagnosis the greater his risk of death, according to a study published in today's issue of the journal, Cancer.
After five years, the death rate for normal weight men from locally advanced prostate cancer was 6.5 per cent, compared with 13 per cent for overweight and obese men.
And, it's not known whether losing weight after a diagnosis of prostate cancer makes a difference in survival.
"To the best of our knowledge this is the first large study using prospective data to evaluate the relationship between obesity and mortality in men treated for locally advanced prostate cancer," the team reports.
About one-third of Canadian men are obese, and an estimated 22,300 men will be diagnosed with prostate cancer this year, according to the Canadian Cancer Society.
Whether excess weight has anything to do with the risk of developing prostate cancer in the first place is controversial, says Dr. Matthew Smith, director of genitourinary medical oncology at Massachusetts General Hospital Cancer Center in Boston.
Some data suggest obesity is a risk factor for aggressive prostate cancer. Other data show that fat men who are treated with radiation or surgery for early stage disease have a greater risk of having a rising PSA, or prostate specific antigen test -- a sign the disease is coming back.
"But the relationship between PSA recurrence and death from prostate cancer is relatively weak," Smith says. "The real question that matters is, OK, you're diagnosed with the disease. Does your body mass index predict your risk of dying from cancer? And that's what we tried to address."
His team reached back into the database of a previously published trial involving 788 men who were followed for more than eight years. All had locally advanced prostate cancer, where the disease hasn't spread to distant organs but is considered high-risk. All received radiation; half got hormone therapy as well.
The study doesn't unravel the link between obesity and poor prognosis, but there are many possible explanations why such an association could occur. For example, obese men might be less likely to be screened for prostate cancer and therefore diagnosed with more advanced disease, and once diagnosed have a worse outcome. It's possible that screening and treatments may also be less effective in obese men.
Blaise Salmon and Bob Dickson
For The Calgary Herald
Sunday, November 18, 2007
Excrement kills, and it kills by the millions. Lack of proper sanitation is the No. 1 cause of infection and the primary enemy of world health. It deprives hundreds of millions of people of health, energy, time, dignity and quality of life.
This issue has been shrouded in discomfort, shame and embarrassment too long. Almost half the world's population, 2.6 billion people, lack access to basic sanitation. More than one billion lack access to safe drinking water.
According to the World Health Organization, 4,500 children die daily from the consequences of unsafe water and sanitation and about 3.4 million children and adults succumb annually. A century ago in Canada, similar conditions were common and life expectancy was less than 50 years. Today, it is over 80. The principal reason for the dramatic leap in average lifespan was the ability to severely curtail the spread of infectious disease, largely through the creation of sewage systems.
The prestigious British Medical Journal recently ranked sanitation as the most important medical advance since 1840, outranking even antibiotics and anesthesia.
There are eight years left until the target date of 2015 for the Millennium Development Goals, the international targets for demonstrable improvements in the human condition. The sanitation goal, which is to halve the proportion of people without basic sanitation, is the least likely of all to be achieved.
There is growing evidence that the lack of progress in sanitation is hampering progress in a number of other MDGs, including gender equity in primary school enrolment, reducing infant mortality rates and promoting economic growth in developing nations.
Less certain is how to make rapid progress on sanitation. Demand for water is well-articulated, whereas demand for sanitation is often hidden and needs to be voiced before systems are designed and implemented. Whereas a new water supply can be installed quickly, successful sanitation programs require long-term psychological and behavioural change.
In recognition of the tremendous need to focus on sanitation and hygiene, the United Nations has officially declared 2008 as the International Year of Sanitation. World Toilet Day is Nov. 19.
Women suffer the most from inadequate sanitation. Journeys to defecate in fields or forests, or even to public latrines, are often stressful and dangerous, especially at night. In addition, women usually bear the responsibility of caring for children and relatives suffering from diseases caused by poor sanitation. Yet women in poor countries typically have the weakest voices in planning and decision-making. Hence, the subsequent failure to impact the political agenda.
Reaching the MDG sanitation target is based on access to the first rung of the sanitation ladder, such as covered pit latrines in rural areas and community sanitation blocks in crowded slums. Covered pit latrines cost as little as $10 each with community sanitation blocks around $25.
Schools and clinics can promote hand-washing with soap and water, the importance of wearing footwear in latrines to avoid infections and parasites, and awareness of how disease is transmitted.
The United Nations Human Development Report for 2006 focused in part on the crisis and called for the creation of a global fund to promote sanitation. With the support of the UN secretary general's Advisory Board on Water and Sanitation, a new Global Sanitation Fund was finalized in October.
Its purpose is to help large numbers of poor people attain safe and sustainable sanitation services and adopt good hygiene practices. It is designed to boost national policies, and will only operate with the explicit welcome of the national governments.
The GSF's main focus is on raising awareness and creating demand rather than on constructing latrines. Experience has shown that latrines will be built by the householders themselves, once they are aware and motivated.
The benefits of improved water and sanitation are not only humanitarian. According to the UN, the financial returns in increased productivity and reduced health costs are estimated at $8 for each $1 invested. A research report this year from the University of California found that the return on investments in sanitation was about $9 for every $1 spent.
A staggering five per cent of Africa's GDP is lost yearly to illnesses and deaths caused by dirty water and the absence of sanitation. In comparison, malaria, which kills more Africans than HIV-AIDS, is estimated to reduce Africa's GDP by 1.2 per cent each year.
The GSF is open to contributions from any source, including governments, foundations, private sector and individuals. Initial funding of $10- to 15 million US is required as a first step toward a target level of $100 million.
Canada has a golden opportunity to make a significant contribution by becoming a founding donor to the Global Sanitation Fund. This would also be a timely way to mark the International Year of Sanitation, and might just put World Toilet Day on the map.
Blaise Salmon is the president of RESULTS CANADA, a volunteer-driven advocacy and educational organization dedicated to ending the worst aspects of poverty and debilitating diseases. Dr. Bob Dickson is a Calgary family physician and a partner with RESULTS CANADA (www.resultscanada.ca)
Canada on cusp of major inroads in mental health
Banff conference to discuss rolling out 'first aid' tools
For the Calgary Herald
Tuesday, November 20, 2007
You don't have to look far to see the human face of mental illness in our society. It's evident on our streets, where huge numbers of the homeless suffer from some form of mental disorder. It's also on our shop floors and in our boardrooms and in any other workplace you can imagine.
Mental illness is not a single disease, but a broad classification for many mental health problems.
A mental health problem might also be described as a mental disorder, poor mental health, psychiatric illness, nervous breakdown and burnout.
Perhaps the most disturbing statistic of many is that two-thirds of adults who experience mental illness never seek help; for adolescents, the figure is 75 per cent.
One of the great frustrations for those of us who have worked in the mental health field for a number of years is to understand the prevalence of mental illness -- and yet witness the yawning gap between the level of need and society's response to the same.
For all of these reasons, the establishment of the Canadian Mental Health Commission, based in Calgary, is welcome news indeed.
As president and CEO of the Alberta Mental Health Board (AMHB), what excites me most about the commission is the opportunity to build upon the work our board has undertaken in recent years, in conjunction with other mental health agencies across Canada. For example, the Commission's 10-year anti-stigma campaign will address negative attitudes and the discrimination people with mental illness encounter every day.
Every province and territory is doing what it can to combat the stigma surrounding mental illness. One of the best examples is a series of print and broadcast ads by the Toronto-based Centre for Addiction and Mental Health featuring high-profile Canadians talking about their personal experiences with mental illness.
Here in Alberta, we are reaching out to one of the most vulnerable groups -- teenagers -- by publishing an online mental health magazine, Grip, and website (www.griponlife.ca), written for and by youth.
When the commission was first established, Senator Michael Kirby said, "The Alberta Mental Health Board is a unique structure across Canada, in terms of the way they look at mental health policy without actually delivering services. I think we can learn a lot from that."
Alberta's approach to mental health is unique in Canada. The AMHB is a provincially funded health authority that oversees Alberta's mental health system.
In addition to advising government, we work directly with the service deliverers -- the province's nine regional health authorities -- to set clear priorities and to ensure, as much as possible, that the quality of services is the same, whether in a major urban centre or a small rural community.
At the same time, we have always recognized the importance of reaching out beyond Alberta's borders to work with, and learn from, our mental health partners across Canada. When it comes to promoting better mental health, no one has all the answers--and we are most effective when we collaborate and share resources.
In fact, Healing Through Sharing was the theme of a special gathering initiated by the AMHB earlier this year in Cambridge Bay, Nunavut, which brought together aboriginal stakeholders as well as representatives of the regional, provincial and federal governments. The idea for the two-day meeting came from the Wisdom Committee, a group of aboriginal elders that advises and guides the AMHB. In particular, it was spearheaded by Bessie Joy, an Inuk who lives in Cambridge Bay and who is a longtime member of the Wisdom Committee.
The gathering proved to be a reciprocal learning experience. The AMHB brought to the table its background in dealing with mental health issues, while Inuit representatives gave us insight into better incorporating aboriginal culture and history in all that we do. I know one of the key priorities of the Canadian Mental Health Commission is to address the special mental health challenges in the North.
Tragically, the Inuit experience suicide rates double that of other aboriginals groups which, in turn, are more than twice the Canadian average. I believe meetings like the one in Cambridge Bay are a positive first step in the national effort needed to start turning around this tragic trend.
The AMHB is also facilitating the rollout across Canada a program known as Mental Health First Aid, based on the model of medical first aid. The program, originally designed and deployed in Australia, is aimed at giving individuals the tools to support friends, colleagues, family members and others who may be developing or experiencing mental health disorders.
As with medical first aid, it isn't necessary to be a trained health professional to offer initial help and this kind of early intervention can make a real difference.
Within Alberta, our goal is to have at least one Mental Health First Aid practitioner in every school in the province. Nationally, we have already trained instructors in Mental Health First Aid in Manitoba, Nova Scotia, New Brunswick and Newfoundland and will soon be taking the program to the rest of the country.
I believe the establishment of the Canadian Mental Health Commission offers a once-in-a-generation opportunity to harness the best and brightest ideas out there and to significantly advance mental health reform in this country. The human need is great and it's time we all rose to the challenge.
Ray Block is president and CEO of the Alberta Mental Health Board. The AMHB third annual Mental Health Research Showcase is Nov. 21 to 23 in Banff. Keynote speaker is Margaret Trudeau, who will talk about her struggle with biopolar disorder.
It looks as if the global AIDS pandemic may not be spiraling out of control after all. Instead, the devastation is stabilizing at an unacceptably high level.
The United Nations’ AIDS-fighting agency and the World Health Organization ate a lot of crow this week for previously overestimating the number of people infected with the virus. As a result of improved methodologies, better surveillance and new understanding of the dynamics of the epidemic, they sharply reduced their estimate — to 33.2 million worldwide from 39.5 million. They now peg the number of new infections per year at 2.5 million, much lower than past estimates.
A few epidemiologists have long charged that the United Nations numbers were wrong, and possibly designed to generate more contributions to battle the disease. We see no sign of any conspiracy. And make no mistake, even with the revised estimates, the AIDS epidemic remains one of the world’s greatest scourges, requiring a strong campaign to bring it under control.
There are, thankfully, glimmers of hope that the epidemic is beginning to wane. The number of new infections peaked in the late 1990s, and the number of people dying from AIDS-related illnesses has declined in the last two years, in part thanks to life-prolonging drug treatments. Officials also point to a reduction in risky sexual practices in some regions of the world.
But it’s hard to rejoice too much when the number of people living with AIDS infections is still rising, more than two million people — mostly in sub-Saharan Africa — are still dying from the disease each year, and eight countries in southern Africa have more than 15 percent of their populations infected, a devastating blow to their societies and economies. The revised numbers cannot be used as an excuse to relax the campaign against AIDS.
November 27, 2007
Our Enemy Hands
By KATHERINE ASHENBURG
IT’S hard to see Americans as under-washed. Sales of antibacterial soap, tooth whiteners and “intimate hygiene” products (wipes and sprays) are skyrocketing. Scientists actually connect the rising rates of asthma and allergies in the West to our overzealous cleanliness. And yet, in a compulsively sanitized culture, cleaning one part of the body — the hands — seems to be more honored in the breach than the observance. Studies show that hospital doctors resist washing their hands, and gimlet-eyed researchers report that only about 15 percent of people in public restrooms wash their hands properly.
Our ancestors would have been bewildered by this discrepancy between relentlessly scrubbed bodies and neglected hands. Depending on their era and culture, they defined “clean” in a wide variety of ways. A first-century Roman spent a few hours each day in the bathhouse, steaming, parboiling and chilling himself in waters of different temperatures, exfoliating with a miniature rake — and avoiding soap. Elizabeth I boasted that she bathed once a month, “whether I need it or not.” Louis XIV is reported to have bathed twice in his long, athletic life, but was considered fastidious because he changed his shirt three times a day.
But through all these swings of the hygiene pendulum, one practice never went out of style — humble, ordinary hand-washing. Which was fortunate, because hand-washing is the one cleansing practice canonized by modern science, a low-tech but effective way to prevent getting and passing on the common cold and infections from Clostridium difficile to MRSA, SARS and bird flu.
Hand-washing made sense in the ancient world, when food was eaten in the hands. Theophrastus’s “Characters,” written in the fourth century B.C., paints a portrait of a hairy, scabby sloven named Nastiness, who doesn’t wash his hands after dinner. But hand-washing was more than pragmatic: it was also a sign of honor and civility, something you offered your guests, via a basin and towel, as soon as they arrived. Since the Greeks believed that any respectful relationship, with gods as well as humans, demanded cleanliness, washing was a necessary prelude to prayer, and sanctuaries usually had fonts of water at their entrances.
For the Romans and Greeks, well-washed hands were a natural accompaniment to fairly clean bodies. The medieval and Renaissance focus on clean hands is more surprising, because those ages had little interest in washing beyond the wrist. It’s true that the Crusaders imported the idea of the Turkish bath into Europe, but even if your town had a bathhouse, it merited a visit only once every week or two.
Clean hands were a different story. Monastery cloisters featured a stone trough for hand-washing, and medieval paintings of interiors often show a ewer, a basin and a cloth for drying hands in a corner of the room. Etiquette books ordered hand-washing before and after meals, and people who neglected it inspired scorn: Sone de Nansay, the wandering hero of a 13th-century French poem, noted with dismay that Norwegians did not wash at the end of a meal.
Among the most fervent hand-washing advocates were medieval poets, who found it difficult to describe a banquet without affirming that everyone present washed his hands before eating, then once again afterward. Unless you washed your hands, you had no claim to gentility.
That belief persisted through the 17th century, even as bodily griminess reached new heights. Doctors assured people that they were more susceptible to the plague if they opened their pores in warm water, and terrified Europeans shunned water and washing, except for their hands. Since forks were not in general use until the 18th century, hand-washing still had a practical function as well as a symbolic one: the Dutch in the age of Rembrandt scandalized French visitors by eating without first washing their hands.
By the mid-19th century, people were timidly experimenting with bathing, but scientists still believed that disease spread through decaying matter and bad smells. When Ignaz Semmelweis insisted that Viennese doctors wash their hands in between performing autopsies and delivering babies, he was ridiculed, even though the practice greatly reduced death from puerperal fever. Semmelweis’s simple but radical idea gained currency only in the 20th century. The germ theory slowly triumphed — but until the development of sulfa and antibiotics, almost the only way to fight microbes was by washing them off.
Even with antibiotics, washing off microbes remains an excellent idea. This ancient mark of courtesy is now celebrated in public health campaigns, and the Centers for Disease Control and Prevention has anointed it as “the single most important means of preventing the spread of infection.” So, learn from science as well as the wisdom of our ancestors, and wash your hands.
Katherine Ashenburg is the author, most recently, of “The Dirt on Clean: An Unsanitized History.”
A non-invasive test that can detect the virus that causes AIDS within seconds is to be unveiled in Montreal today.
The 60-second HIV test gets a jump on current, laboratory-run tests that usually take seven to 10 days to process.
The Health Canada-approved test can be done in a doctor's office using a droplet of blood from a fingertip. The INSTI testing kit detects antibodies for the HIV virus using a chemical dye.
"Patients can get immediate, accurate results and avoid the gruelling 10-day wait period," Matthew Clayton, executive vice-president of bioLytical Laboratories of British Columbia, said in a telephone interview.
Tested on 16,500 people during the past two years, it proved 99.96 per cent accurate, Clayton said.
A positive result would require further testing in a laboratory, he added.
It's an excellent screening tool that will help limit HIV spread, said Mark Wainberg, head of the McGill AIDS Centre.
A member of bioLytical's scientific advisory board, Wainberg said the test has real benefits.
An estimated one in four people don't know they are infected with HIV, and these people are considered the fastest spreaders of the infection, he said.
"There's evidence that those informed (of their HIV status) will modify their behaviour, and that's a big plus -- that's what our study aims to do," Wainberg said.
Wainberg, who got a donation of 5,000 kit samples from the manufacturer, is to launch a screening pilot project from mobile clinics using the instant test.
The project aims to target a vulnerable population, mostly men who sleep with men, that doesn't want to go to hospitals and clinics, said Michel Morin, assistant executive director of COCQ-Sida, an anti-AIDS coalition.
One-third of kids' playthings had lead
CanWest News Service
Thursday, November 29, 2007
Nearly one-third of popular children's toys chosen for testing by CanWest News Service contained detectable levels of lead, raising questions about the safety of products being marketed to kids this holiday season.
One set of paints tested positive for lead levels close to the proposed federal limit -- but even Health Canada says its lead limits are too high to adequately protect public health. Health Canada says lead risks should be taken seriously because "even very low levels of lead into the blood may have harmful health effects on the intellectual and behavioural development of infants and young children."
Parents may not realize lead can have a significant impact on their child because the medical community typically only warns about extreme cases, in which children can die after ingesting large amounts, said David Lean, a toxicology professor at the University of Ottawa.
"You will see damaging effects with any amount of lead," he said. "We could have a lot of sick kids in this country because of lead exposure."
CanWest News Service chose toys for testing after speaking with 10 Canadian families with children of various ages and asking what toys their children play with or want for Christmas. The university's Earth sciences lab conducting the tests also selected several toys in order to include products with a wide range of surface materials and textures.
Three toys were found to contain detectable levels of lead when tested at the U of O lab: a Warhammer Battle for Skull miniatures paint set, a Pirate Playset figurine purchased from a dollar store and a puzzle cube from a dollar store.
The yellow paint colour in the Warhammer paint set had the highest levels of lead compared to the other toys, at 60 milligrams per kilogram, according to the lab tests.
A proposed federal standard would limit lead in children's paints to 90 milligrams per kilogram. Health Canada's current limit for lead in children's toys is 600 milligrams per kilogram, but common industry practice for children's paints sets a limit of 90 milligrams per kilogram.
The company that makes the Warhammer set, Games Workshop, said the yellow paint should not test for higher lead levels than others because the same pigment is used for other colours in the set. After speaking to its supplier, the company said some contamination must have occurred that resulted in the presence of lead, and "it is most probable" that took place when paint was put in containers. The company added it conducts its own tests and places a high priority on safety.
Officials from Dollarama did not respond.
The Canadian Toy Association said the industry has always taken safety seriously and the mounting number of recalls in the past few months has prompted companies to put an even greater priority on the way toys are made and how they're tested.
'Why would we tolerate lead in toys?'
Toxicology expert says not to excuse low-level exposure
CanWest News Service
Thursday, November 29, 2007
CREDIT: Henry Romero, Reuters
Mattel Inc. destroyed more than 160,000 toys in Mexico on Wednesday because of harmful levels of lead.
Everywhere he looks, Bill Radosevich finds lead: a rubber wagon wheel a toddler loved to put on its side and spin for half an hour at a time (1.5 per cent lead), plastic ducks, backpacks, vinyl lunch boxes, plastic caps on glue sticks, zipper pulls, sipping cups, pacifiers and teething rings.
"I've got some baby teething rings that have a couple of hundred to a couple of thousand parts per million of lead," says Radosevich, who screens toys for lead for the Minneapolis-based company Thermo Scientific.
In Canada, it's against the law to sell paint containing more than 600 milligrams of lead per kilogram.
The debate over whether the lead scare in toys has been oversold is like the argument about second-hand smoke, says toxicologist Len Ritter.
"People will pontificate and develop all kinds of nice mathematical algorithms to describe the risk if you're only exposed for 10 minutes a day," says Ritter, executive director of the Canadian Network of Toxicology Centres and professor of toxicology at the University of Guelph.
"The bottom line is you just don't want to be exposed to second-hand smoke. It's the same thing with lead. It's not good for a child and it's a waste of time to try to spend a lot of time developing a fancy approach to try to excuse some low-level exposure," says Ritter.
"We managed to get lead out of fuel. Why would we tolerate lead in toys?"
Lead is toxic to the brain. Not only does it not serve any function in the human body, the greatest impact is on the developing brain. Young children are particularly vulnerable because their small bodies are exquisitely efficient at absorbing lead.
Evidence suggests that once a child is unduly exposed to lead, the damage has already been done. Elevated blood lead levels in children have been linked to behaviour problems, slowed reaction times, problems reading and learning, lower IQ, hyperactivity, aggression and inattentiveness. At high levels, it can cause liver and kidney damage, and even death in extreme and rare cases.
Johns Hopkins Bloomberg School of Public Health scientists recently found lead reduces the number of new neurons in the part of the brain important for learning and memory, and blunts the ability of these newborn neurons to communicate with one another.
What's considered an "acceptable" exposure, or blood level of lead has been falling over the years. "It keeps coming down because every time we set a new lower limit, somebody publishes a paper to suggest that even at this new lower limit there is evidence of some adverse effect," Ritter says.
Very high blood lead levels can cause symptoms of poisoning such as stomach pain, vomiting, diarrhea or even death. But long-term exposure is more insidious, and it may not be clear to parents that a child's change in behaviour could be due to lead.
"You don't want to get to the point where these children are scoring with lower IQs, you begin to build the story backward and discover, aha, they were exposed to lead for a significant part of their childhood," Ritter says.
How much time, and at what level, children need be exposed to lead before they suffer harm is a crapshoot, he says. "In the public health, the position we take is to say the target, when achievable, is zero. Why would you want your child to play with a toy that will provide exposure to lead?"
But some doctors say the real risk in terms of exposure to lead-containing toys is unknown, as is whether toys containing lead-based paint are leading to elevated lead levels in children.
"The numbers are probably still not out there in terms of a direct link to toy recalls" and elevated blood lead levels in kids, says Dr. Sharon Swindell, clinical assistant professor of pediatrics at the University of Michigan. "How old is the child, what's the child doing with the toy, is the child putting it in its mouth a lot, what's the condition of the paint on the toy? We need to be looking at all these things together."
If a parent knows they have a toy that has been recalled that their child played with frequently or put into his or her mouth, and if there's evidence the paint isn't intact or smooth, they should ask their pediatrician or doctor for a lead test.
Symptoms can, but don't always include behaviour changes, aggression, constipation and stomach pain.
Still, the greatest risk of lead exposure is the home, in the lead-based paint flaking off the walls of older homes and the tap water passing through lead-soldered pipes. Before 1976, interior paints contained high amounts of lead. Even if the leaded paint has been covered over with layers of newer paint, the old paint can still peel off with the new layers. Children can get poisoned if they chew on lead-painted windowsills or lead paint flakes. Dust that collects on sills can get on a child's hands and into his or her mouth.
For concerned parents approaching Christmas toy shopping, Radosevich believes the companies that have had the most recalls "are probably going to be the safest to go with."
"The major toy brands are frantically refining their quality-control methods to make sure that they're catching lead before it ends up in any toy on the shelf."
Parents should talk to store owners and insist the store owners make sure their toys are lead-safe, he says.
THE SYMPTOMS OF LEAD EXPOSURE
Even low levels of lead exposures may harm a child's intellectual development, behaviour, size and hearing. Often there are no symptoms, but at higher levels of exposure, signs of lead poisoning include:
- Muscle and joint pain
- Stomach aches and cramps
- Problems with learning and reading
- Hearing loss
- Delayed growth
Sources: American Academy of Child and Adolescent Psychiatry; Health Canada
November 30, 2007
Problematic Medical Scans
CT scans have long been cited as a prime example of how the overuse of fancy medical technologies can drive up the cost of health care. Now there are newly voiced concerns that computed tomography, or CT, may be a health risk as well.
The scans, which were introduced in the 1970s, have revolutionized medical imaging by producing three-dimensional views of organs and other tissues. The scans are undeniably of great value in helping doctors diagnose just what is causing a patient’s illness or pain. But a critique published in The New England Journal of Medicine by two researchers at Columbia University’s Center for Radiological Research warns that usage has spread so rapidly that high, lifetime doses of radiation are now becoming a pubic health hazard.
More than 62 million CT scans were performed in the United States last year, a huge increase from the 3 million performed in 1980. And each scan gives the patient a far higher dose of radiation than a conventional X-ray would. Unfortunately, even many doctors have no idea how much radiation a CT scan delivers.
The risk that a single CT scan might cause cancer is very small, and the medical benefits of diagnosing an ailment far outweigh the slight radiation risk. The problem comes when CT scans are not medically appropriate, such as full-body scans to screen patients who feel fine on the chance that some hidden disease might be detected, or when CT scans are repeated again and again as patients traipse from one doctor to another while their medical records lag behind.
The researchers cite previous estimates that a third of all CT scans performed in the United States could be replaced with less risky diagnostic technologies or not performed at all. If true, that means that some 20 million adults and 1 million children in this country are being irradiated unnecessarily each year. In coming decades, the researchers suggest, as many as 2 percent of all cancers in the United States may be because of radiation from CT scans performed today.
Even if these predictions are on the high side, as some radiologists and medical device manufacturers contend, the message for patients and their doctors is clear: Restrict the use of CT scans to cases where they can truly aid in diagnosis and consider other options, such as ultrasound or magnetic resonance imaging, which have no radiation risk.
Do as we say, not as we do. That would seem to be the message that both the Calgary Board of Education and the Calgary Catholic School District are sending their students by refusing to ban junk food from cafeterias and vending machines while preaching to kids that this same food is bad for them.
CBE spokesman Ted Flitton says the reason for this is that "when you impose a ban, I think you shut off the thinking."
This is not a philosophical or political debate, so there is really no thinking that needs doing here.
It's a no-brainer. Junk food is bad. It's loaded with sugar, salt and fat, and its increased consumption is linked to an alarming surge in rates of Type 2 diabetes among children, obesity and high cholesterol in teens, something which traditionally has been associated with the over-40 demographic, not the under-20 one.
Why there need to be vending machines in schools at all is a corollary to this. It used to be that kids brought their lunches to school or ate in the cafeteria, and then went home to have a snack after school.
But if vending machines are now a fact of life in the halls of academe, there is no reason why the CBE and the Catholic division cannot decree that they be filled exclusively with healthy foods. The choices are abundant -- yogurt, bottled water, single-serving cheese slices and fruit cups are just a few that come to mind.
Sometimes, adults need to make decisions for the well-being of children, rather than leave it up to the kids, and this is one of those times.
Besides, just how effective is a classroom message about healthy eating when it is preached two steps from a hallway lined with vending machines crammed with pop, potato chips and candy bars?
EDMONTON - Cellphones can already hook you up to music, photos and the Internet, but how about your vital signs?
A new project between Edmonton researchers and a Korean electronics giant could soon allow you to test and transmit your temperature, heart rate and blood pressure to a remote nurse using a handheld device connected to a cellphone.
The University of Alberta and Capital Health are teaming up with LG Electronics to develop a sensor device that would fit in your pocket and -- if you're feeling woozy at the shopping mall or flushed on the golf course -- let you send your vital signs to a health-care professional for advice and help.
The technology would be especially useful for seniors with limited mobility, and those living in remote and northern communities who may have high blood pressure or need monitoring when they start new medications.
Eventually, the research team hopes to target diabetics by creating a device that can also monitor unstable glucose levels and chemicals in the blood.
Starting in January, Bob Haennel, chairman of the physical therapy department at the U of A, will test prototypes of the monitor in university labs before it reaches patients in clinical trials. He envisions a device that's built into a cellphone, just like MP3 players or digital cameras.
Patients would carry the phone, then squeeze or insert their fingertips into it when they're feeling ill to have the information sent to a health professional. A cardiac patient facing mild angina might be able to get immediate advice if the tool registers unusual heart rhythms or rising blood pressure.
"What happens if I'm not in a hospital?" Haennel asked. "Then I have my heart rate and blood pressure right away. This would be another piece of the health-care arsenal."
December 25, 2007
The Lure of Treatments Science Has Dismissed
By ABIGAIL ZUGER, M.D.
Skip to next paragraph
SNAKE OIL SCIENCE
The Truth About Complementary and Alternative Medicine.
By R. Barker Bausell.
Oxford. 324 Pages. $24.95.
The ailing millions who spend their money on unorthodox medical treatments may differ in their preferences for powders vs. needles vs. the sound of cracking bones, but they do share a single mantra: “I don’t care what the studies say; it works for me.”
The studies — at least the good ones — say that none of these treatments work the miracles often claimed for them. And in this contradiction lies the genesis of R. Barker Bausell’s readable, entertaining and immensely educational book, which undertakes to explain exactly why treatments that science says do not work that well are still able — even likely — to work for you.
It is probably no good recommending that every devotee of alternative medicine spend some time with this book, as should those who gobble up prescription drugs for all the wrong reasons, and the thousands of doctors out there chanting their own version of the same mantra (“I ignore what studies say, and patients love me anyway”). All these departures from scientifically validated therapies tend to be accompanied by a disdain for the statistics supporting them, and Dr. Bausell, a statistician and professor at the University of Maryland in Baltimore, has no particular magic tricks up his sleeve — just numbers, logic and a virtuoso command of the medical literature.
But a stint directing research into alternative medicine has familiarized him with the thought patterns of those who use it, those who are inclined to prescribe it and those whose research seems to support it. He writes with a sense of humor and palpable compassion for all involved, and in the regrettably likely event that he winds up preaching exclusively to the choir, his book will be no less of a tour de force.
Dr. Bausell starts out with the story of his late mother-in-law, Sarah, a concert pianist who developed painful arthritis in her old age and found her doctors to be generally useless when it came to satisfactory pain control. “So, being an independent, take-charge sort of individual, she subscribed to Prevention magazine, in order to learn more about the multiple remedies suggested in each month’s issue” for symptoms like hers.
What ensued, according to Dr. Bausell, was a predictable pattern. Every couple of months Sarah would make a triumphant phone call and announce “with great enthusiasm and conviction” that a new food or supplement or capsule had practically cured her arthritis. Unfortunately, each miracle cure was regularly replaced by a different one, in a cycle her son-in-law ruefully breaks down for detailed analysis.
He makes it crystal clear exactly how the natural history of most painful conditions conspires with the immensely complex neurological and psychological phenomenon known as the placebo effect to make almost any treatment appear to work, so long as the recipient hopes and believes it will.
With equal dexterity Dr. Bausell introduces us to Dr. Smith, a fictional physician who becomes interested in acupuncture and convinced that it helps his patients. Enthusiastically organizing a series of research studies to confirm his conviction, Dr. Smith falls victim to an even more complicated set of scientific, psychological and emotional confounders than did Sarah, all of which invalidate his science and make his treatment appear far more effective than it actually is.
It is, of course, not only research into alternative therapies that is compromised by the pitfalls Dr. Bausell describes. Exactly the same subtle problems bedevil orthodox research, and they are often the source of the contradictory studies and here-today-gone-tomorrow treatment vogues that drive patients crazy.
Nor are patients who are using alternative treatments the only ones to become all wrapped up in the soothing folds of the placebo effect. The word “placebo” has picked up some pejorative overtones in the last few decades, with connotations of trickery and deceit, cold-eyed white-coated investigators doling out sugar pills instead of the real things. In fact, though, placebos have as venerable and honorable a history as just about any medication, and are better studied than most.
Dr. Bausell explores the science behind placebos in detail: the pain relief they afford is reliable and reproducible, and for some reason tends to linger in memory as even stronger than it really is.
But is that placebo-generated pain relief real or imaginary? Patients generally roll their eyes when the argument gets to this stage, for as Dr. Bausell points out, one perfectly reasonable response to the question would be, “Who cares?”
But it turns out that the issue is more than just scientific nitpicking. Placebos may work, but their effects are characteristically mild and temporary; in fact, they are more or less indistinguishable from the effects of most alternative treatments, as the dozens of studies summarized in the book’s last 100 pages make clear.
Still, Dr. Bausell knows perfectly well that people in pain don’t care what studies say. The only study they care about is the study of themselves. And who can blame them for that?
Thus he includes a final, ingenious section titled, “How to select a placebo therapy that works,” suggesting, among other things, that consumers bent on trying alternative medicine find an appealing therapy and an enthusiastic practitioner, then plunge in wholeheartedly to maximize that placebo effect and prolong its duration for as long as possible. Pure scientists might shudder at this advice, but Sarah’s son-in-law knows better.
Chronic pain can make us feel isolated and helpless, especially if its cause is an illness or physical condition for which there's no cure or effective medical treatment. At times of deepest despair, finding ways to nurture our spirits can help us not only cope with the pain, but also discover nuggets of grace, comfort, and productivity that can move us through and beyond the helplessness and hopelessness we feel. Here are ten spiritual tools that can help you get started toward peace in spite of and in the midst of pain.
Maureen Pratt is a speaker and author who focuses on spirituality, faith and wellness. Her most recent book is "Peace in the Storm: Meditations on Chronic Pain & Illness" (Doubleday Religion). Her website is www.maureenpratt.com.
January 17, 2008
$300 to Learn Risk of Prostate Cancer
By GINA KOLATA
A combination of common and minor variations in five regions of DNA can help predict a man’s risk of getting prostate cancer, researchers reported Wednesday.
A company formed by researchers at Wake Forest University School of Medicine is expected to make the test available in a few months, said Karen Richardson, a Wake Forest spokeswoman. It should cost less than $300.
This is, some medical experts say, a first taste of what is expected to be a revolution in medical prognostication. The results, they agree, are clear. But the question is what happens next. And will patients be helped or harmed? Because the new test — which will analyze DNA in blood or saliva samples and is to be offered by ProActive Genetics — cannot predict which men will get aggressive cancers, it could lead to more screening and unnecessary surgery and complications. But, proponents say, it could also help men decide whether they want aggressive screening in the first place.
The researchers found that about 90 percent of the men in the study had one or more of the gene variants and more than half had two or more. The cancer risk increased as the number of variants rose and increased substantially when men had four or five of the variants.
Men with four or five variants made up only 2 percent of the study population but had a 4.5-fold increased risk of having prostate cancer compared with men who had none of the variants. If the men also had a family history of prostate cancer, their risk was nearly 10 times higher than that of men with none of those risk factors. Less than 1 percent of the population had all the variants and a family history.
The researchers report that nearly half of the cases of prostate cancer among the roughly 5,000 men in the study could be attributed to the five gene regions and a family history, with some men having one or two of the gene variants and others having all five and a family history.
Prostate cancer becomes more common as men age — autopsies of elderly men find that most had prostate cancer, whether they knew it or not. But the men in this study had an average age of about 65, when the disease is less common and more likely to kill.
William B. Isaacs, a professor of urology and oncology at Johns Hopkins University and an author of the new report, said that if research validates what has been found, men may want to get the new genetic test when they are young, 35, say. Those at high risk because of their genetics might then choose to start prostate-cancer screening earlier than the usual age of about 50, using a blood test that looks for proteins secreted by prostate tumors.
“I think that makes sense,” said Dr. Howard Sandler, a professor of radiation oncology at the University of Michigan and a spokesman for the American Society of Clinical Oncology.
But others worry that more frequent testing could exacerbate what is already a major problem: most prostate cancers grow so slowly that they would have been harmless if left alone. But since doctors cannot tell which are dangerous, they treat nearly all that they find. And treatment has serious side effects, including, often, impotence and incontinence. Nonetheless, researchers say, the test is a harbinger of things to come.
“It’s the boutique medicine of the future,” said Dr. Peter C. Albertsen, a surgery professor and prostate cancer specialist at the University of Connecticut. “We can know what diseases we will have to face in the rest of our lives.”
That worries him, as it does Dr. Edward P. Gelmann, deputy director of the Comprehensive Cancer Center at Columbia University. “Technology today enables us to find out a huge amount of information,” Dr. Gelmann said. “But how does the public deal with this information? How does it help them make decisions? And if they make a decision, does that lead to a day, a week, a month, of life saved?”
The study, by scientists at Wake Forest University School of Medicine, the Karolinska Institute in Sweden, the Harvard School of Public Health, and Johns Hopkins Medical Institutions, will appear in the Jan. 31 issue of The New England Journal of Medicine. It was released online on Wednesday, a journal spokeswoman said, because “it is a very active area of research with a lot of competition.”
Researchers long knew that the disease often runs in families. Though scientists spent years looking for genes, they found none that were reproducibly associated with a marked effect.
With new technology to scan the entire length of a person’s DNA, researchers tried a new approach. They began looking for small variations in tiny DNA regions that were associated with prostate cancer. That resulted in the discovery, by several groups of investigators in Iceland and the United States, of the gene variants, small alterations in gene sequences. Unlike traditional genetic links to disease, the variants are not mutations that destroy a gene’s function. In fact, no one knows what their effect is.
The next step was to ask whether those variants really could predict who had prostate cancer. So Dr. Jianfeng Xu, a professor of epidemiology and cancer biology at Wake Forest University School of Medicine, and his colleagues studied a Swedish population of 2,893 men with prostate cancer and 1,781 men who did not have it. That led to their finding that each of the five variants independently predicted prostate cancer risk.
“Each confers a moderate risk,” Dr. Xu said, adding that the effect of having just one of the variants — a 10 or 20 percent increase in a man’s chance of having prostate cancer — was not enough to justify using a single variant for screening. But, he added, because each conferred an independent risk, the risks added up so that the more men had, the greater their risk. Then they found that family history of the cancer added an independent risk. “That was very, very surprising to us,” Dr. Xu said.
The next step, Dr. Isaacs said, is to look in other populations. “We think that can happen almost instantaneously,” he said, explaining how scientists have blood samples and family histories of thousands of men who were tested for prostate cancer.
But some said that if the test leads to more screening, it is not necessarily a good thing. There is already too much prostate-cancer screening, they say, resulting in too much treatment. “To me, it is a nightmare,” Dr. Albertsen said. “We are just feeding off of this cancer phobia.”
What is needed, and what the new test does not provide, is a way to decide which cancers are dangerous and which are not, Dr. Isaacs said. Still, he said the new test could help patients if it was used with caution. “We may be premature with this idea — everyone has a different way of thinking about this — but it should not take five years to know if we are on the right track. All this can happen very rapidly.”
“We have worked with enough families that have a positive family history to know that people are anxious to know their risk of prostate cancer,” he said.
Too much water bad for you: doctors
Abnormal amounts of protein found in urine
Canwest News Service
Friday, January 18, 2008
Canadian doctors are warning that drinking too much water may cause loss of kidney function -- something they discovered purely accidentally.
Researchers who have been studying the health of residents of Walkerton, Ont., since the water supply was contaminated with E. coli in 2000, identified 100 otherwise healthy adults who had a condition called proteinuria, or abnormal amounts of protein in their urine. None had any medical conditions or were on medications that would explain why.
Proteinuria can cause kidney failure and is a sign of microvascular disease, where the heart's tiny arteries are damaged, causing cardiac disease and cardiac death.
Of the 100 people, 56 agreed to follow-up testing and to reduce their fluid intake to fewer than eight large glasses per day for one week. The result? The cases of proteinuria were "largely reversed."
"When we were in Walkerton, we were surprised that almost five per cent of the population were drinking very large volumes of fluid," said Dr. William Clark, a scientist at Lawson Health Research Institute in London, Ont., and professor of medicine at the University of Western Ontario.
"We went on the supposition that this must be because of the water contamination," meaning when people moved to bottled water, they drank more. But Clark, project leader of the Walkerton Health Study, said most admitted drinking vast amounts of water before the contamination, for health reasons.
They were drinking, on average, at least four litres of fluid per day. "That would be about 18 large glasses of fluid per day," Clark said. Some people were drinking six litres. One woman, a health-care worker, was drinking eight.
"Most corrected their kidney abnormality (after reducing water intake)," Clark said. "Some did not correct completely, meaning they may have a permanent bit of damage."
What's not known is "whether the proteinuria associated with excessive fluid intake in these otherwise healthy people will affect their kidney function in the long term," the researchers write in this week's Canadian Medical Association Journal. Until the final data is in, "it may be advisable to discourage otherwise healthy people from consuming large volumes of water."
"This was something we've never conceived of. It's not reported anywhere," Clark said in an interview, adding until "we know better . . . maybe eight glasses of fluid a day is fine, but probably less than six is better, unless you're in a very arid climate or carrying out marathon running or massive exertion or have a particular kind of kidney damage and you lose salt."
February 1, 2008
Nets and New Drug Make Inroads Against Malaria
By DONALD G. McNEIL Jr.
Widespread distribution of mosquito nets and a new medicine sharply reduced malaria deaths in several African countries, World Health Organization researchers reported Thursday.
The report was one of the most hopeful signs in the long battle against a disease that is estimated to kill a million children a year in poor tropical countries.
“We saw a very drastic impact,” said Dr. Arata Kochi, chief of malaria for the W.H.O. “If this is done everywhere, we can reduce the disease burden 80 to 85 percent in most African countries within five years.”
There have been earlier reports of success with nets and the new medicine, artemisinin, a Chinese drug made from wormwood. But most have been based on relatively small samples; this is the first study to compare national programs.
“This is extremely exciting,” said Dr. Michel Kazatchkine, executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “If we can scale up like this everywhere, we should be able to eliminate malaria as a major public health threat in many countries.”
The report was done by a team from the World Health Organization for the Global Fund, the chief financing agency for combating malaria. It looked at programs in four countries that tried to distribute mosquito nets to the families of every child under 5, and medicines containing artemisinin to every public clinic.
In Ethiopia, deaths of children from malaria dropped more than 50 percent. In Rwanda, they dropped more than 60 percent in only two months.
Zambia, Dr. Kochi said, had only about a 33 percent drop in overall deaths because nets ran short and many districts ran out of medicine. But those areas without such problems had 50 to 60 percent reductions, he said.
Ghana was a bit of a mystery, according to the report. It got little money from the Global Fund, Dr. Kochi said, and so bought few nets and had to charge patients for drugs. Malaria deaths nonetheless fell 34 percent, but deaths among children for other reasons dropped 42 percent.
Holding drives to distribute insecticide-impregnated nets is a growing trend, now that the Global Fund, the President’s Malaria Initiative, United Nations agencies, the World Bank and private fund-raisers like AgainstMalaria.org have offered hundreds of millions of dollars. Such drives must be continuous because “permanent” nets wear out after three to five years.
The report, finished in December, was an effort to find hard data, which has long been a problem with malaria, especially in rural Africa, where anyone with fever is often presumed to have malaria and medical records scribbled in school notebooks are rarely forwarded to the capital. For this study, researchers tallied only hospitalized children whose diagnoses were confirmed.
Rwanda, a small country that handed out three million nets in two months in 2006, had 66 percent fewer child malaria deaths in 2007 than in 2005.
Ethiopia, much larger, took almost two years to hand out 20 million nets; it cut deaths of children in half.
In Africa, malaria is a major killer of children, but so are diarrhea and pneumonia, which have multiple causes, as well as measles, which has been declining as the Global Alliance for Vaccines and Immunization has expanded.
Until the recent infusions of money from international donors and the reorganization of malaria leadership at the W.H.O., the fight against malaria had been in perilous shape, with nets scarce, many countries using outdated or counterfeit medicines, spraying programs dormant and diagnoses careless.
Even the most commonly cited mortality figure — one million deaths of children a year — has always been no more than an educated guess.
February 24, 2008
The DNA Age
Insurance Fears Lead Many to Shun DNA Tests
By AMY HARMON
Victoria Grove wanted to find out if she was destined to develop the form of emphysema that ran in her family, but she did not want to ask her doctor for the DNA test that would tell her.
She worried that she might not be able to get health insurance, or even a job, if a genetic predisposition showed up in her medical records, especially since treatment for the condition, alpha-1 antitrypsin deficiency, could cost over $100,000 a year. Instead, Ms. Grove sought out a service that sent a test kit to her home and returned the results directly to her.
Nor did she tell her doctor when the test revealed that she was virtually certain to get it. Knowing that she could sustain permanent lung damage without immediate treatment for her bouts of pneumonia, she made sure to visit her clinic at the first sign of infection.
But then came the day when the nurse who listened to her lungs decided she just had a cold. Ms. Grove begged for a chest X-ray. The nurse did not think it was necessary.
“It was just an ongoing battle with myself,” recalled Ms. Grove, of Woodbury, Minn. “Should I tell them now or wait till I’m sicker?”
The first, much-anticipated benefits of personalized medicine are being lost or diluted for many Americans who are too afraid that genetic information may be used against them to take advantage of its growing availability.
In some cases, doctors say, patients who could make more informed health care decisions if they learned whether they had inherited an elevated risk of diseases like breast and colon cancer refuse to do so because of the potentially dire economic consequences.
Others enter a kind of genetic underground, spending hundreds or thousands of dollars of their own money for DNA tests that an insurer would otherwise cover, so as to avoid scrutiny. Those who do find out they are likely or certain to develop a particular genetic condition often beg doctors not to mention it in their records.
Some, like Ms. Grove, try to manage their own care without confiding in medical professionals. And even doctors who recommend DNA testing to their patients warn them that they could face genetic discrimination from employers or insurers.
Such discrimination appears to be rare; even proponents of federal legislation that would outlaw it can cite few examples of it. But thousands of people accustomed to a health insurance system in which known risks carry financial penalties are drawing their own conclusions about how a genetic predisposition to disease is likely to be regarded.
As a result, the ability to more effectively prevent and treat genetic disease is faltering even as the means to identify risks people are born with are improving.
“It’s pretty clear that the public is afraid of taking advantage of genetic testing,” said Dr. Francis S. Collins, director of the National Human Genome Research Institute at the National Institutes of Health. “If that continues, the future of medicine that we would all like to see happen stands the chance of being dead on arrival.”
Caught in a Bind
For Ms. Grove, 59, keeping her genetic condition secret finally became impossible. When her symptoms worsened she was told to come back to the clinic before antibiotics would be prescribed. But there had been a snowstorm that day, and she could not summon the strength to drive.
“I have alpha-1,” she remembers sobbing into the phone. “I need this antibiotic!”
The clinic called in the prescription.
Ms. Grove, who does freelance accounting from home and has health insurance through her husband’s employer, allowed herself to be identified here because she said she felt an obligation to others — including some in her own family — to draw attention to the bind she sees herself in.
“Something needs to be done so that you cannot be discriminated against when you know about these things,” she said. “Otherwise you are sicker, your life is shorter and you’re not doing what you need to protect yourself.”
Employers say discrimination is already prohibited in the workplace by the Americans with Disabilities Act and existing laws governing privacy of medical records. But employee rights advocates say nothing in those laws explicitly prevents employers hard-pressed to pay for mounting health care costs from trying to screen out employees they know are more likely to get sick.
Courts have yet to rule on the subject. When the Equal Employment Opportunities Commission sued the Burlington Northern Santa Fe Railway for secretly testing the blood of employees who had filed compensation claims for carpal-tunnel syndrome in an effort to discover a genetic cause for the symptoms, the case was settled out of court in 2002.
And in 2005 when Eddy Curry, then the center for the Chicago Bulls, refused a genetic test to learn if he was predisposed to a heart ailment, the team traded him to the New York Knicks.
Insurers say they do not ask prospective customers about genetic test results, or require testing. “It’s an anecdotal fear,” said Mohit M. Ghose, a spokesman for America’s Health Insurance Plans, whose members provide benefits for 200 million Americans. “Our industry is not interested in any way, shape or form in discriminating based on a genetic marker.”
Still, a recent study by the Georgetown University Health Policy Institute found otherwise. In 7 of 92 underwriting decisions, insurance providers evaluating hypothetical applicants said they would deny coverage, charge more for premiums or exclude certain conditions from coverage based on genetic test results.
The Medical Cost
Regardless of whether discrimination actually occurs, many health care professionals say the pervasive anxiety over it demands legislative action. Geneticists complain that discrimination fears prevent them from recruiting research participants, delaying cures and treatments for disease. At Memorial Sloan-Kettering Cancer Center in New York, the same concern is a leading reason people cancel appointments for tests that detect cancer risk.
“We are dealing with potential lifesaving interventions,” said Dr. Kenneth Offit, chief of the center’s clinical genetics service. “It’s a tragedy that people are being scared off by this.”
The Genetic Information Nondiscrimination Act, which passed the House of Representatives by a wide margin last year, would prohibit insurers from using genetic information to deny benefits or raise premiums for both group and individual policies. (It is already illegal to exclude individuals from a group plan because of their genetic profile.) The bill would also bar employers from collecting genetic information or using it to make decisions about hiring, firing or compensation. But it has yet to reach the Senate floor.
Meanwhile, a $300 genetic test for prostate cancer risk announced last month immediately drew callers to a public radio station in Washington that was discussing the test, voicing fears of insurance discrimination. Dr. Karim Kader, who made the test possible with his discovery that men who carry certain DNA variants are four to five times likelier to develop prostate cancer, assured one caller that the test would be “very private.”
For some, that is not good enough.
Linda Vahdat, director of the breast cancer research program at NewYork-Presbyterian Hospital/Weill Cornell Medical Center, estimates that 20 percent of her patients choose to pay for the DNA test for inherited breast cancer risk with cash, to avoid submitting insurance claims.
And last year, hundreds of customers paid the start-up company DNA Direct for tests that range in cost from $175 to $3,456 to ensure that no third party, not even a doctor, had access to their results. Mary, a freelance camera assistant in Brooklyn, for instance, sent a swab of her cheek cells to DNA Direct to find out if her extreme fatigue was caused by hemochromatosis, a genetic condition in which the body retains too much iron.
“I would rather not lay out the $200 myself,” said Mary, who requested that her last name be withheld for the same reason she paid for her own test. “But it seemed safer.”
Treatment for hemochromatosis typically involves removing a unit of blood twice-weekly by phlebotomy. But that would mean disclosing the condition to a doctor, so Mary is planning on becoming a frequent blood donor.
Kathy, a financial analyst in Houston who would like to know if she, like her two sisters, has a genetic predisposition to breast cancer, said she was not going to take even an anonymous test. “Then,” she said, “I’m just in a position of having to lie.”
The culture of secrecy around genetic information is stronger in the United States, some experts say, than in countries where people are guaranteed health care. Among Americans at risk for Huntington’s disease, an incurable brain disorder, only 5 percent take the DNA test to determine if they will develop it, compared with 20 percent of Canadians in the same position, according to Michael R. Hayden, a professor of human genetics at the University of British Columbia in Vancouver.
Here, doctors often feel obligated to inform patients of the potential financial downside.
“I always warn them,” said Dr. Stephen Moll, director of the Thrombophilia Program at the University of North Carolina, who uses a genetic test to determine the best treatment for patients with blood clots. “Especially if they are self-employed, I don’t want it to be a surprise if their health insurance premium goes up.”
After receiving a similar warning from her doctor, Katherine Anderson’s parents did not allow her to be tested for Factor V Leiden, a genetic condition she might have inherited from her father that increases the risk of blood clots.
But last year, with nothing in Ms. Anderson’s record to indicate reason for concern, a gynecologist prescribed a birth control pill to regulate her uneven periods. Six weeks later, Ms. Anderson, then 16, developed a clot that stretched from her knee to her abdomen. The pill, combined with the gene she had indeed inherited, had increased her clotting risk by 30-fold.
Now largely recovered, her primary concern is whether she will be viewed as a health insurance liability for the future.
“I don’t want to have to work for a big business just to get insurance,” she said. “This could be determining what I can do for my whole life.”
For Judith Berman Carlisle, the price of privacy was forgoing the DNA test that would have convinced her not to have surgery. Ms. Carlisle, 48, who was setting up her own therapy practice, was afraid testing positive for the high-risk breast and ovarian cancer gene that runs in her family would prevent her from buying health insurance.
But her sister had developed ovarian cancer the year before, an aunt had died of it, and Ms. Carlisle was desperate not to get it herself. Her doctor agreed to remove her ovaries based on her family history — the way such decisions were commonly made before a genetic test was available.
Ms. Carlisle was convinced the surgery would be less damning than proof that she carried a defective BRCA1 gene, which also confers a very high chance of developing breast cancer.
“There’s a big difference between someone saying, ‘I have a strong family history,’ ” Ms. Carlisle said, “and saying, ‘I only have a 13 percent chance of not getting breast cancer during the time you’re insuring me.’ ”
Last fall, after the surgery to remove her ovaries, she began to consider a double mastectomy to remove any chance of breast cancer, the disease her grandmother and another aunt had died of. Having secured health insurance, she took the test for the BRCA1 mutation. It came back negative.
“The first thing they said to me,” Ms. Carlisle said, “is that I have no higher risk than anyone on the street.”
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