"When many cures are offered for a disease, it means the disease is not curable" -Anton Chekhov
''Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.'' -Robert Ehrlich, drug advertising executive.
"Opinions are like sphincters, everyone has one." - Chris Rangel
Mad Science: One of the two fertility specialists involved in a heated race to clone a human, Cypriot-cum-Kentuckian Panos Zavos claims he's cloned a baby:
Last April the first scientific evidence that cloning was taking place was published in a reputable medical journal. In Reproductive BioMedicine Online, which is edited by Edwards, Zavos published the first data showing that a human embryo had been cloned.
Edwards said: “This is, to the best of my knowledge, the first formal report on steps leading towards this objective.
“Having never disguised his intentions , Zavos presents brief data on his approach to human cloning by utilising methods seemingly compatible with cloning certain animal species.”
And yesterday, when Zavos announced that he had implanted a cloned embryo into a woman, he had the support of another British fertility expert, Dr Paul Rainsbury, who backed his claims.
Rainsbury, consultant gynaecologist and medical director of the Regional Centre for Reproductive Medicine at Bupa Roding Hospital in Ilford, said: “I believe this embryo has been implanted in a 35-year-old woman. I have no reason to believe it didn’t take place.”
The embryo was implanted in the last two weeks. This weekend Zavos hopes to be able to tell whether it is growing . If the tests are positive, Zavos will have another first to add to his achievements.
The last time we heard such a claim, it was from his rival, Severino Antinori. Nothing ever came of it. Only time (ten months or less) will tell if anything comes of this. posted by Sydney on
1/17/2004 09:06:00 PM
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SARS Wars: Two of the three suspected SARS cases in China have been confirmed as SARS. The good news is that both patients have fully recovered and seem to have had mild illnesses. Across the border in Hong Kong, however, they're still taking no chances. They're on "yellow alert":
When hundreds of passengers disembarked here recently from a train from nearby Guangzhou, they faced a gantlet of medical workers in face masks and white latex gloves.
First the new arrivals walked in front of an infrared camera that measured the temperature of each person's skin and clothing; a health worker carefully watched a computer screen attached to the camera for the faces showing in red, indicating possible fever. A little farther along, a nurse directed people who looked the slightest bit unhealthy to another pair of nurses who took their temperatures using a digital ear thermometer; all children, regardless of health, also had to be checked with the thermometers, since the infrared cameras might not record their temperatures accurately.
Finally, the arrivals were allowed to approach immigration officers and hand them their passports or identity cards, along with health cards distributed on the train. The cards asked for their recent travel histories and whether they had come in contact with the disease everyone here still fears: SARS.
"We have screened out many people with flu and other respiratory infections," but none yet with SARS, said Dr. Henry Kong recently as he supervised the screening of the train passengers.
....Because SARS victims spread the virus most quickly when they are very sick, Hong Kong has declared a 'yellow alert.' SARS tests are conducted on anyone who contracts pneumonia; hundreds of isolation wards are now available for people who may be suspected of having the disease. Tourists and residents alike are being reminded to wash their hands frequently, which Dr. Lam Ping-yan, Hong Kong's health director, describes as the most important measure people can take. Tour guides have been briefed on how to prevent SARS, and hotels have been told to clean public areas more frequently. Roads and alleys remain almost spotless after a cleaning campaign during the last outbreak, but battalions of street cleaners are still at work, and the city is stepping up its already considerable efforts to trap or poison rats.
But that's nothing compared to a "red alert":
Hong Kong is prepared to declare a "red alert" and take tougher measures if any SARS cases actually surface in its own territory. Revisions to the health laws give extensive powers to the police in tracking down SARS patients and people they associate with and quarantining them.
That may seem like overkill, but Hong Kong did have 300 deaths from SARS last year, and given its tendency to be especially virulent among healthcare workers, it strained their hospitals terribly. Their vigilance is understandable. posted by Sydney on
1/17/2004 08:24:00 AM
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Better Late than Never: Other medical weblogs have noticed this already, but here's a blogging doc - an orthopedist with a sense of humor. Welcome, bloggingdoc. posted by Sydney on
1/16/2004 08:25:00 PM
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Refocus: I really don't mean for this to become a Dean/Steinberg blog. But, time slipped away this morning (and last night when I usually surf the web for medical stories), thanks to paperwork that needed finished, so I didn't get the chance to post other, more medical subjects. They require more thought than I could give them this morning. But stay tuned. I promise to refocus on medical matters. posted by Sydney on
1/16/2004 08:42:00 AM
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More Mrs. Dean: The Mrs. Dean/Dr. Steinberg story is a natural for Maureen Dowd. Curiously for a career woman, she doesn't seem to know what to make of Dr. Steinberg:
The doctors Dean seem to be in need of some tips on togetherness and building a healthy political marriage, if that's not an oxymoron.
Even by the transcendentally wacky standard for political unions set by Bill and Hillary Clinton, the Deans have an unusual relationship.
....Many women cheered Judy Steinberg as a relief and a breakthrough. Why should she have to feign subservience in 2003, or compromise as Hillary Rodham and Teresa Heinz did when they took their husbands' names? But many political analysts said that just as the remote technocrat Michael Dukakis needed Kitty around to warm him up, the emotionally chilly Howard Dean could benefit from the presence of someone who could illuminate his softer side. So far he has generated a lot of heat but little warmth.
And at a moment when he's under attack by Democratic rivals for reinventing his political persona and shifting positions, he could use a character witness on the road to vouch for his core values
....Even some who admired Dr. Steinberg's desire to stay focused on her own life, healing the sick, still thought it odd that she would be so thoroughly disengaged from her husband's wild political ride, missing the thrilling moments and the poignant ones, like the repatriation ceremony of his brother's remains in Hawaii.
...."What will she tell their grandkids?" wondered one political reporter here. "Yeah, Grandpa was once a front-runner for president with crowds all over America cheering him but I was too busy to go see it?"
It will be interesting to see, if her husband falters, whether the exigencies of politics will require her to make a house call on his campaign.
Physician, heal thy spouse.
It's a mistake to judge a person by their spouse - in real life and in politics. Any "softening" of Howard Dean's image would just be an illusion. It's far better that we get him unfiltered through the lens of his wife.
And another reader, also a physician, supports Dr. Steinberg's decision:
As a pulmonary physician, I found your reader's comments about Dr. Steinburg (1/14) rather offensive. Dr. Steinburg is a hematologist. As you certainly know, that's a very busy specialty; she's taking care of leukemia and bone marrow transplant patients among others. [hematologists usually also double as cancer specialists, so it's safe to say that she has patients with intensive medical and emotional needs -ed.] It would certainly be a breach of the trust her patients have in her if she just took off suddenly to campaign with Gov. Dean. Sure, she can arrange coverage like we all do, but her patients certainly expect her to be there for them more often than not.
Dr. Steinburg could decide to put her practice on hold for a while; I suspect she could pick it up again afterward if the Governor doesn't win (though it wouldn't be easy). But having made a commitment to see her patients, she needs to be there for them. I admire her for taking the position she has.
Gov. Dean has a lot of problems, and I don't intend to vote for him. But his wife's career really ought to be out of bounds.
A final comment: I'm a fellowship director, so I get to write evaluations of my trainees. The message in Dr. Dean's evaluation came through loud and clear! Wonder if he had the nickname "Mad Dog" back at Yale? posted by Sydney on
1/16/2004 08:28:00 AM
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Quiz: Who said this?
"You'd destroy the health care system in this country if you had Medicare for everybody."
Truth and Beauty: We have a tendency to mistake beauty for goodness, and evidently we're guilty of it even in the practice of medicine:
And good looking individuals get different treatment in some situations you might least expect it, such as a doctor's office.
“We see in medical interactions, patients who go to physicians ,and those of higher physical attractiveness, the physicians will spend more time with that person and will also spend more time answering individual questions that that person asked,” says Dr. Patzer.
And this special treatment starts very early on.
“For example, in a nursery, before newborn babies are released from a hospital, those babies who are higher in physical attractiveness, at this level defined as more cute , are touched more, held more and spoken to more,” says Dr. Patzer
I have to confess, I'm guilty of this, at least when it comes to babies. I make more of a fuss over cute babies in the nursery, when no parents are around to watch me. (When parents are around, I make an equal fuss over everyone.) posted by Sydney on
1/15/2004 10:42:00 AM
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Dean Questions: Another reader has some questions about Howard Dean and his temperment:
I want to know more about Howard Dean the doctor but I can't find much information even though the web has thousands of sites about Howard Dean the politician. How did he perform in medical school and residency and later in his practice as judged by the physician and nursing staff with whom he worked? What did his peers think of his competence for the practice of medicine? What was the opinion of him as a doctor by his patients? And how long did he actually practice medicine? It seems he was elected to state government the second year after he entered practice in Vermont. If he was as impulsive and short tempered in medical practice as he seems to be as a politician, how did that affect his ability to perform as doctor? Answers to these questions might shed light on how he would perform a President of the United States, a position of responsibility and leadership many times more demanding than being a governor.
I think it's safe to say that Governor Dean enjoys politics more than he enjoys medicine. Otherwise, he'd be in Shelbourne with his wife. Regarding his anger and impulsivity, the New Yorker ran this quote from one of his residency evaluations:
Likewise, during Dean’s residency, one of his supervisors wrote in an evaluation, “Howard is a very solid resident, a good teacher, intellectual in his approach. His major problem continues to be one of impulsive syntheses when problems are approached. He should take care to be more deliberate in making assessments and deciding upon plans. Because of this trait, he is not quite the superior physician that he is in other respects.”
(The New Yorker profile persists in the same mistake that the rest of the media continues to make. Dean's practice was in internal medicine, not family medicine. I suppose it's an honest mistake for a Manhattan reporter to make. Sometimes it seems as if there's nothing but specialists on that island. His wife is also an internist, not a family physician. She subspecializes in hematology, in addition to practicing internal medicine.) posted by Sydney on
1/15/2004 10:11:00 AM
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Reader Flu Remedies: The post about down-home flu fixes brought these emails about other home remedies. Both factual:
My late father alleged that sweating out a cold, usually overnight, would shorten or prevent it. I use it myself when I get that "oh oh, tomorrow I'll have a cold" feeling-lots of blankets and comforters, an extra hour of sleep-and I don't believe I've ever developed a cold afterwards. Hardly a clinical trial. Of course, a diet high in fresh vegetables and fruit could have something to do with it, too. But, contrawise again, my father's diet was conspicously short of fresh veggies and fruit, so back to square one on the research.
Defending Dean: The New York Times insinuates that there's something wrong with Mrs. Dean/Dr. Steinberg because she hasn't given up her practice to go on the cmpaign trail. But it takes a long time to build a successful medical practice. It only takes a few weeks of absence to tear it all down. And, she must be the one earning the money to put those kids through college, right?
The other thing about a medical practice is that it's more than a full time job. You can't just drop everything and jet to the next campaign appearance every weekend - even if you have partners. Whenever one person from a group is absent, the others have to do more than fair share of the work. Too frequent absences foster resentment, unless there's a good reason - such as serious illness. Supporting a husband's political ambitions wouldn't qualify in most groups.
UPDATE: A reader says I'm missing the point about Mrs. Dean:
Her absence is going to hurt Dean's campaign. People want to know what they are getting when they vote for a president.
Why is his wife MIA? Could it be that she isn't that sold on him being president? Could be. Is she ashamed to be seen in public with the guy? Can't this guy who wants to be the leader of the free world even convince his wife to support him publically?
Personally, I find this woman strange and creepy. If all she wanted to do was run a medical practice, she should have chosen another guy to marry. What's wrong with her...and him?
Also, her independent feminism is really off-putting. Even Hillary, one of the most independent (if not the most) first lady in history, was frequently seen by her husband's side.
This is going to help doom Dean. It certainly won't help.
It's possible to support your husband without being attached to him at the hip. And although I realize that for a significant portion of voters, her absence will be off-putting (as will be the fact that she doesn't wear make-up or power-pink suits), she has legitimate reasons not be on the campaign. It's wrong to base an estimation of Dean as a leader on his wife's entirely understandable decision to continue to work. There's a lot that's wrong with Howard Dean, but his wife isn't one of them.
And one more thing - Hillary Clinton got a lot of praise for being the first career woman First Lady, but her career was so wrapped up in her husband's, that she was really no different than other powerful and influential First Ladies (Nancy Reagan, Eleanor Roosevelt.) I'd rather have a First Lady like the two Bushes (Laura and Barbara) or Judith Steinberg who limit themselves to the role of spouse, and stay out of politics.
Coincidence: One of my elderly patients was telling me a story of an illness she had when she was about twenty years old. She was so sick, she said, that the doctor drove her to the hospital himself. She added as an aside, "And he was President Eisenhower's doctor." Here's more about the good doctor and his famous patient. posted by Sydney on
1/14/2004 08:29:00 AM
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Bill McInturff, a Republican pollster, said one of his surveys last month found that "affordable health care" ranked second, just below the economy and jobs, and above terrorism and national security, when voters were asked to list their most important issues. It is particularly important among women, Mr. McInturff said.
Evidently, people are forgetting the real threats out there to our national security. Sadaam may have been captured, but there are still a lot of hostile radical nations out there to be guarded against. And even if we hadn't been attacked by Islamofascists, national security should still take precedence over healthcare. I'd rather live in a strong and free nation and pay for my own medical care than in a decaying or conquered one with free healthcare.
Oxycontin Economics: OxyContin may go generic soon, and that has some worried that lower prices will mean more abuse:
If the price is reduced because the source is able to get it cheaper and sell it cheaper, then there's going to be more widespread distribution to a wider customer base,' said Sgt. Darrell Crandall, the Maine Drug Enforcement Agency supervisor for Washington County, one of the areas where OxyContin addiction and abuse first took hold in Maine in 2000.
Down Home Alabama: A Michigan couple (originally from Alabama) shares their down home flu remedies:
Davenport squeezes the juice from several lemons into water and adds the rinds and boils the liquid until the water starts turning brown. He adds a tablespoon or so of honey and a bit of whiskey. (The amount of whiskey varies, depending on who it's for: His adult children get a double shot; his grandchildren -- the youngest is 12 -- get about a tablespoon.
He gets it as hot as his patients can stand to drink it and encourages them to drink it before it cools off.
Then the sick one is tightly tucked under the covers. Sweating is to be expected! After the sweating ends, he or she changes clothes, gets back in bed and sleeps.
Sleep is as much a part of the remedy as the mixture, Sampson Davenport said.
His tonic hasn't failed a Davenport yet. Usually, one dose plus rest does it for a bad cold or the flu.
It might not cure the flu, but I bet it makes you feel better. I'm not so sure about his wife's remedy, though:
Mattie Davenport, a retired registered nurse, also believes in home remedies, though.
Several years ago she passed on a remedy to Remonia Chapman of Detroit, who directs the Minority Organ and Tissue Transplant Program, a division of the Gift of Life Michigan.
Whenever Chapman feels a cold or flu coming on, she swallows a teaspoon of baking soda, quickly followed by some juice.
``You have to drink some type of juice behind it to keep it down so you won't gag,'' Chapman said. ``All my friends laugh at me and say it's gross, but I tell you what, I haven't had a serious cold or the flu since I've been doing this. And I've been doing this for almost seven years.'' posted by Sydney on
1/13/2004 08:30:00 AM
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Maintaining: A new study has shown that exercise, without dieting, is more beneficial than doing nothing:
Overweight adults who are not on a diet need only a small amount of exercise -- the equivalent of a half-hour of brisk walking per day -- to prevent further weight gain, a study found.
Participants who got no exercise during the eight-month study gained an average of almost 2.5 pounds. But 73 percent of those who briskly walked 11 miles a week, or about 30 minutes a day, were able to maintain their weight or even lose a few pounds.
Even better, if you exercise and diet, you'll lose more weight than if you just diet. There's another advantage to exercising. After spending so much time and hard work on it, you're less likely to sabotage yourself by cheating on your diet. posted by Sydney on
1/13/2004 08:23:00 AM
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Knitting the Ravelled Sleeve of Care: A couple of new sleeping pills are in development, which means that soon insomnia will be the disease du jour:
A new effort appears to be developing to expand the use of sleeping pills, which because of their potential for abuse have long had a reputation as being in some ways more dangerous than the insomnia they are meant to treat.
Some sleep experts say newer pills are safer than the ones that once caused deaths from overdose. Moreover, some say, there is growing evidence that insomnia is a serious medical condition, not just a nuisance.
'Slowly, we are beginning to identify that insomnia does have some risks associated with it, and when that happens there will be more press to treat it aggressively,' said Dr. Michael H. Bonnet, director of the sleep laboratory at the Veterans Affairs Medical Center in Dayton, Ohio.
No doubt about it. Lack of sleep can impair function. It dulls the reflexes, causes a mental fog, and induces emotional fragility. But this is a bit worrisome:
But part of the new push is driven by drug company marketing. Two new sleeping pills are expected to be available by the end of next year and their manufacturers hope to have them approved for broader and longer-term use than recommended for previous pills. And the companies are expected to advertise their products, and the problem of insomnia, heavily."
The problem with advertising insomnia (and other medical conditions) heavily is that it begets the "medical student syndrome." It's a well known fact that medical students begin to suspect they have every malady they learn about when they recognize the symptoms described in the textbook in themselves. The same thing happens with endless exposure to disease symptoms in magazines and television. People who are little shy are convinced they have a social phobia. Others who are sad, or not happy all the time, become convinced they have depression.
And the same thing will happen with insomnia. There will be those who sleep less than eight hours a day, or who occasionally have a sleepless night who will become convinced they have insomnia and that they must have the latest pill, at all costs. Since occasional sleeplessness is as common as occasional unhappiness, expect these new drugs to take off with the same vigor as SSRI's have. And, since changing sleep patterns are a part of growing older, expect those new Medicare drug beneficiaries to be responsible for a large share of the demand. As one drug company advertising executive put it, "Once you tell people there's a cure for something, the more likely they are to pressure doctors to prescribe it.''
American medicine and pharmaceuticals - doing our best to spend our children's future now. And without losing sleep over it. posted by Sydney on
1/13/2004 08:06:00 AM
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Puzzling Case: CNN is reporting that the British military has acknowledged that vaccines given to British soldiers in the first Gulf War are the cause of Gulf War Syndrome. But the case is dubious, at best. And the only thing the leaked document proves is that the military's pension board gave a soldier a handsome pension:
A leaked British Army medical report has provided the first official backing that vaccines given to British soldiers before the 1991 Gulf War caused illnesses associated with Gulf War Syndrome, the Times reported on Monday.
It said Lieutenant-Colonel Graham Howe, clinical director of psychiatry with the British Forces Health Service in Germany, made the link after the War Pensions Agency asked him to look at the case of former Lance-Corporal Alex Izett, who now suffers from osteoporosis and acute depression, the paper said.
The Times quoted Howe as saying in his unpublished report, dated September 2001 and handed to the paper by Izett, that 'secret' injections given to the soldier 'most probably led to the development of autoimmune-induced osteoporosis.'
Howe came to that conclusion because in the end Izett was never posted to Iraq, the Times said.
That may have satisfied a British pension board, but it wouldn't have made it past a worker's comp hearing here. "Autoimmune-induced osteoporosis" isn't a condition I'm familiar with. I don't believe it exists. People with autoimmune diseases are often treated with steroids, and it's these steroids that cause glucocorticoid induced osteoporosis.
Autoimmune diseases crop up in people for no discernable reason. We don't understand their etiology very well, in many cases, and so they are often wrongly labelled as being caused by something outside the body, when in fact, they are caused by the body turning on itself. It was autoimmune disease that spurred the silicone breast implant mess and all the bad science it encompassed. It's impossible to assert that an injection, or series of injections (the report, as quoted by CNN, doesn't say they were vaccines) is responsible for one man's autoimmune disease. To make that assertion, you need many people with the same symptoms who had the same series of injections. There's nothing mentioned about that here, nor in the many studies done to evaluate Gulf War Syndrome.
The other disturbing thing about this report is that it's based on a psychiatrist's opinion. No offense to psychiatrists, but their area of expertise does not encompass autoimmune disorders. The pronouncement would have carried more weight if it had been based on the opinion of a rheumatologist or an immunologist. Looks like the British Army just wanted to give the guy a pension without a lot of hassle. And now the media are misinterpreting it as "evidence" that vaccines cause Gulf War Syndrome. But based on this case, there isn't even enough evidence to prove that vaccines cause autoimmune disorders. posted by Sydney on
1/13/2004 07:51:00 AM
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Procrastination by Any Other Name: A psychological theory for writer's block:
Flaherty believes ''there are perhaps only two types of writer's block, high energy and low energy.'' The low-energy type may be a symptom of treatable depression, which ''afflicts writers at a rate 8 to 10 times higher than the general population.'' High-energy block comes from an excess of anxiety, thereby demonstrating something called the Yerkes-Dodson law, which Flaherty describes as ''venerable,'' although it was a small revelation to me.
In a 1908 study, Robert M. Yerkes and John D. Dodson, who were doing research in comparative psychology at Harvard, found that ''both very low and very high levels of arousal interfere with performance.'' In other words, too much motivation, as well as too little, can trigger writer's block, and this explains why ''the bigger the project, the bigger the block.'' Coleridge may be the most famous example of this syndrome; he produced pages of essays, correspondence and journalism -- to the point of hypergraphia, in fact -- but when it came to the form that mattered most to him, poetry, he had a tendency to choke
The author suggests imagining another project that's even more important than whatever it is you're currently working on to overcome a block. That way, you can use your real work to procrastinate from doing the imagined work. Or you could write a book about procrastinating. One like Why I Have Not Written Any of My Books . posted by Sydney on
1/12/2004 07:42:00 AM
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Ancient Microbes: A 2,000 year old leper has been unearthed in Jerusalem:
Up until now, the oldest archaeological findings of leprosy were from the Byzantine period, in the fifth century C.E.,' says Gibson. 'This is the oldest archaeological finding of leprosy in the Middle East. Leprosy is mentioned in the Bible, but until now, we could not be sure whether these biblical references are to the disease we know as leprosy, or to something else.
Sticker Shock: Healthcare costs are going up more quickly than expected, in fact, beyond belief. And the biggest culprit? Drugs:
Prescription drug spending was the fastest-rising aspect of health costs at 15.3%.
It isn't only that drugs are so expensive, but that we're prescribing them in such large numbers. Never before have there been so many drugs to chose from for so many non-urgen problems - SSRI's for PMS, statins for elevated cholesterol, proton pump inhibitors for indigestion (which is what they often end up being used for), etc. etc. And the fact that a large chunk of the population is about to get their choice of drugs paid for by the government isn't going to help matters. posted by Sydney on
1/12/2004 07:36:00 AM
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Mad Cow Update: Researchers are trying to clone a cow immune to madness. If only we could do the same with humans. posted by Sydney on
1/12/2004 07:34:00 AM
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SARS and Civets: China now has a third possible SARS case, despite the culling of civet cats. It isn't as widespread as it was last year at this time, though, probably because they're keeping their eyes open for cases. But their efforts to eliminate the believed source of the virus aren't going so well, largely due to artful civet farmers like this one:
When the cull was announced, because of a study in Hong Kong that found the coronavirus believed to cause Sars in civet samples, he went further underground, operating under the title 'Special Vegetable Farm'.
Extreme Aesthetics: Taking plastic surgery a little too far.
UPDATE: A reader emails that the site is satire:
I think this website is a fake, or the entire clinic is. There are numerous questionable points- the first being this biological matrix they use- that completely degrades but leaves bone behind. I'm sure our reconstructive surgery colleagues would love to see such a material. Too bad it doesn't exist. Second, they say it attaches to bone- but clearly, in the photos, it isn't. They also talk about having a dermatologist, surgeon, and doctor on staff- perhaps this is how the Dutch talk, but I bet surgeons and dermatologists would find that a bit offensive.
The dead giveaway, though, is the last page. Get a load of that motley crew! And the implants. They're pottery. The last line of the last page says something about thanking the "European Ceramic Work Centre" for support in research and development.
Clever though- I wonder why they wasted hours on this website. And why I'm wasting minutes debunking it.
Prion Doubts: Steven Milloy takes a critical look at prions as the cause of mad cow disease and its human counterpart. He says that the prion theory doesn't meet Koch's postulate of infectivity - which includes the successful growth of the agent in a lab culture. But prions are just twisted bits of protein. How could they possibly be expected to grow in a culture dish? posted by Sydney on
1/11/2004 01:29:00 PM
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Aspirin and Cancer:If I had to choose one drug to include in a first aid kit, I would choose aspirin. It eases pain, subdues inflammation, and cools a fever. And best of all, it can improve the chances of survival for someone in the throes of a heart attack. But now, researchers are saying that this miracle drug is not so miraculous:
Aspirin's reputation as a wonder drug could be dented by recent US research suggesting that long-term use might increase the risk of pancreatic cancer.
A study found that women who took two or more 325mg aspirin tablets a week for more than 20 years were 56% more likely to develop the disease than those who took lower doses less often.
Heavy users, taking 14 or more tablets a week, were 86% more likely to contract the often fatal condition.
The results, based on a study of aspirin use by 88,378 women nurses and reported in the Journal of the National Cancer Institute, run counter to much promising research about the drug.
That's bad news. Pancreatic cancer is a very bad cancer. It's invariably fatal. It's also very rare - which means ample room for error in statistical manipulations of the sort used by the study. (Link doesn't work. Go here, scroll down to reference #1 and click on "Free Full Text.". This will take you to the abstract. Click on "Full Text" and you should be able to access it for free.):
Among 88,378 women without cancer at baseline, we documented 161 cases of pancreatic cancer during 18 years of follow-up.
That's an incidence of 0.002%. To make up for those small numbers, the authors had to resort to expressing their results in terms of person years, rather than giving us the number of people in each of their aspirin use categories. They also chose to express their results only in terms of "relative risk" further inflating their numbers. The number of cases in each category are very small. The true incidence is impossible to determine from the given data. And yet, one of the lead authors felt compelled to make this statement to The Guardian:
But Eva Schernhammer, the leader of the research team from Harvard medical school in Boston, advised against prolonged use of aspirin.
The report said: "Our findings do not support a protective effect of analgesic use after extended periods of use. Risks and benefits associated with the use of aspirin have to be weighed carefully in any recommendations made by health care professionals.
Of course risks and benefits have to be weighed before using any drug, including aspirin, but the risk of pancreatic cancer pales in comparison to the risk of heart disease or stroke, both of which regular aspirin use, in doses less than those examined in the study, can reduce. An aspirin a day still keeps the doctor away. posted by Sydney on
1/11/2004 01:11:00 PM
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Trendy Medicine: The New York Times takes a probing look at the latest trend among cancer centers:
The 2,000 people, the worried well, who come each year to Memorial Sloan-Kettering's cancer prevention center will learn that many cancers can, in fact, be prevented, and that it is up to them to have the appropriate medical tests and to live right.
For their $2,000 fee, most of which is paid by health insurance, they may be steered to smoking cessation sessions, or watch a cooking demonstration and hear a talk by a nutritionist. They will learn the early signs and symptoms of cancer and they almost certainly will have a cancer screening test.
Are those services worth all of that money? Probably not:
But, some ask, how can an honest message be communicated to the public about what can be done?
"I am concerned," said Dr. Donald Berry, a statistician at M. D. Anderson. "Most of what this is about is research. I think we're really early on in the cancer prevention area. Knowing what to do, knowing what the risk factors are and knowing when to intervene and how to intervene — we're not there yet."
He and others worry that many people greatly exaggerate their cancer risk and have inflated expectations of what science can do to protect them.
....Dr. Otis Brawley, associate director for cancer control at the Winship Cancer Center at Emory University, shared Dr. Gallo's view. "To be politically correct as a cancer center you have to be interested in prevention," he said. The government expects it and so do patients, he added. "It is like a lot of things in medicine where we have implied success where actually there is very little."
..."The person in the street greatly exaggerates their risk of cancer," Dr. Berry said. One thing a cancer prevention center can do, he said, is let people know their real risk and the real effect of measures that many think will give them cancer, or protect them from it.
"We can be letting them know that changing their lifestyle may change their risks, but not by much," Dr. Berry said. "We can be letting them know that while hormone therapy may increase the risk of breast cancer, it does not increase it much."
But, Dr. Berry, we can't charge them $2,000 a head just to give them advice!
Better to Give: George Harrison's estate is suing his former doctor, not for malpractice, but for grasping:
A lawsuit last week evoked a distressing image of the former Beatle George Harrison, weak and exhausted, near the end of his life, being coerced into signing autographs by the doctor who was treating his cancer.
Dr. Gilbert Lederman of Staten Island University Hospital has denied through a spokesman that any coercion took place, saying that he and his patient had become close and that Mr. Harrison had freely autographed a guitar belonging to Dr. Lederman's son.
Dr. Lederman has now offered to donate the guitar to charity. But the lawsuit, filed by Mr. Harrison's estate, also said the doctor had violated his patient's privacy by giving repeated television interviews within hours of Mr. Harrison's death. The episode, however it is resolved, raised the uneasy question of how far doctors and hospitals can go in accepting gifts, gestures of friendship or endorsements from their patients.
